JUDICIAL BODIES BY-LAW APPLICATION FORM FOOTBALL FEDERATION AUSTRALIA Level 22, 1 Oxford Street, Darlinghurst NSW 2010 Locked Bag A4071, Sydney South NSW 1235 Telephone: +61 (2) 8020 4000 Facsimile: +61 (2) 8020 4100
Judicial Bodies By-Law Application Form PLEASE NOTE THIS FORM SHOULD ONLY BE USED IF AN FFA STATUTE DOES NOT PRESCRIBE A RELEVANT APPLICATION FORM 1. JURISDICTION FFA Disciplinary and Ethics Committee - Complete sections 2.1 and 3 to 9 Jurisdiction: 1. Dispute between: (a) (b) FFA and a Constituent in relation to a decision made by FFA, or sanction imposed by FFA on a Constituent, as a result of a finding by FFA that a Constituent has breached one or more of the FFA Statutes; or an FFA Club and a Player in relation to a decision made by an FFA Club, or sanction imposed by an FFA Club on a Player, as a result of a finding by an FFA Club that a Player has breached the National Code of Conduct. 2. Matter referred for determination to the Disciplinary and Ethics Committee pursuant to the A-League Disciplinary Regulations, W-League Disciplinary Regulations, National Youth League Disciplinary Regulations, FFA Cup Disciplinary Regulations or National Premier Leagues Finals Series Disciplinary Regulations. FFA Appeal Committee - Complete sections 2.2 and 3 to 9 Jurisdiction: 1. Appeal of a Determination of the FFA Disciplinary and Ethics Committee Dispute. 2. Appeal of decision of appeal committee or appeal tribunal of a State Body Member, but only if the: (a) (b) State Body Member s grievance procedure has been fully exhausted; and the sanction to be appealed from is one of the following: (i) (ii) a fine greater than $3,000; or a suspension of six (6) or more matches. 11 November 2015 2
2. TYPE OF APPLICATION AND DETAILS OF DISPUTE 2.1 Disciplinary and Ethics Committee Briefly state the relevant facts and legal arguments in the space below. You must include a clear statement of the issues you are submitting to the Disciplinary and Ethics Committee for determination. If necessary, continue in an annexure: 2.2 Appeal If this is an application to hear an appeal of a Determination of the Disciplinary and Ethics Committee or an appeal of the decision of an appeal panel or appeal tribunal of a State Body Member, you must include a copy of the Determination being appealed and confirm the following details: Date of decision: D D / M M / Y E A R Decision made by: The sole grounds of appeal are as set out in clause 23.1 of the Judicial Bodies By-Law. On what ground/s are you appealing the above decision: the party was not afforded a reasonable opportunity to be heard; the Determination was affected by bias; the Determination was one that was not reasonably open to the Panel having regard to the evidence before it. In addition, you may also briefly state your grounds of appeal. If necessary, continue in an annexure: 11 November 2015 3
3. APPLICANT / APPELLANT DETAILS Applicant/Appellant Name: Contact name and title: (if applicant/appellant is an entity) Address for service of notices: Telephone: Mobile: Fax: Email: 4. RESPONDENT / APPELLEE DETAILS Respondent/Appellee Name: Contact name and title: (if respondent/appellee is an entity) Address for service of notices: Telephone: Mobile: Fax: Email: 11 November 2015 4
5. DATE OF RELEVANT DECISION Insert date on which the decision was made by FFA, or the sanction was imposed by FFA or the date of receipt of the Determination being appealed: D D / M M / Y E A R 6. RELIEF SOUGHT Please describe the relief you are seeking from the FFA Disciplinary and Ethics Committee or the FFA Appeal Committee (as applicable) and the provision of the relevant FFA Statute that provides for such relief. If necessary, continue in an annexure: 7. URGENCY Are there grounds for suggesting that these proceedings should be heard on an urgent basis? Yes [ ] No [ ] If yes, please describe below the basis for the urgent hearing of the matter and the requested timeframes: 8. INSTRUCTIONS FOR LODGING APPLICATION 8.1 Application Fee The application fee for: 11 November 2015 5
(a) (b) a determination of the Disciplinary and Ethics Committee is AUD$500.00; and an appeal to the Appeal Committee is AUD$2,000.00. The application fee is non-refundable and must be lodged at the time of making this application. Payment of the application fee can be made by cheque or directly into the FFA bank account. Bank: Bank Address: Account Name: National Australia Bank 255 George Street, Sydney 2000, NSW, Australia Football Federation Australia Limited Account Number: 562 584 036 Branch/Swift Code: 082-057 I attach confirmation of payment to FFA of the relevant application fee. 8.2 FFA Contact Details You should address any correspondence, applications or other general queries to the Administrator at the address below: Football Federation Australia Level 22, 1 Oxford Street, Darlinghurst NSW 2010 Locked Bag A4071, Sydney South NSW 1235 Ph: (02) 8020 4000 Fax: (02) 8020 4100 9. SIGNATURE OF APPLICANT / APPELLEE I warrant that the information contained in this Application Form is true and correct. Signed: Name: Position: Date: D D / M M / Y E A R Your privacy: FFA collects your personal information so we can administer the FFA Disciplinary Committee and the FFA Appeal Committee. Your information will be shared with members of the Judicial Bodies. You have a right to access certain personal information that we collect and hold about you. You may contact us at privacy@ffa.com.au. A copy of the FFA privacy policy is available at www.ffa.com.au/privacy. 11 November 2015 6