ESFA GRIEVANCE FORM

ESFA GRIEVANCE FORM
Applicant Details
Member Applicant*
FFA Number
Email Address*
A copy of your submission will be emailed to this address.
Type of Application
Is your application in reference to a “claim” or “complaint”?*

ClaimComplaint

Respondent Details
Member Respondent*
FFA Number
Respondent Email
example@example.com
If there are further parties who are Respondents, please provide their details below.
Affected Parties

Your application for relief may have consequences for another party. ESFA is concerned to ensure such as the Affected Party (including ESFA) is aware of your application and is provided with an opportunity to be heard.
Is there another party potentially directly affected by your appeal? *

YesNo
Please provide the name and contact details of the affected party.

Representation
Do you wish to be represented by a support person of the Club? *

YesNo
Do you wish to be represented by a lawyer?*

YesNo
Jurisdiction

ESFA's jurisdiction in relation to Grievances is set out in section 13.9 of the Competition Rules. ESFA will only hear a Claim or Complaint in the following circumstances:
(a) The Applicant and Respondent are Members of the ESFA as defined in Section 5 of the ESFA Constitution; and
(b) The Applicant and Respondent have exhausted the processes set out in section 13.9 of the ESFA's Competition Rules.
Does the Judiciary Committee have jurisdiction to hear this matter?*

YesNo

Date Grievance Rose
Grievance date *

DayMonthYear
If you wish to, provide a timeline of events below.
Details of the Grievance
Briefly state the relevant facts and legal arguments including any relevant sections in the FA Rules and Regulations, Football NSW Rules and Regulations or the ESFA's rules and regulations that may apply.
You must include a clear statement of the issues you are submitting.
Please submit all documents that have been provided by each party under section 13.9 of the ESFA's Competition Rules

Upload a File
Max file size 4MB. Allowed files types pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, jpg, jpeg, png, gif Cancelof
Relief Sought
Please describe the relief that you are seeking*
Notes:

1. Please submit this form within 14 working days after the dispatch of the notice referred to in section 13.9 of the Competition Rules

2. Members should read and consider ESFA's Schedule D - Disciplinary Procedure prior to signing and lodging this Form to ESFA.

3. Your Claim or Complaint will be dealt with by mediation in the first instance unless ESFA believes that the claim or complaint should be referred to a Judiciary Hearing.

4. If the ESFA does not receive a properly completed Form by the time specified in Section 1 above, the Member has waived its right to file a Grievance with the ESFA.
Submission
Your name*

First NameLast Name
Digital Signature*

I certify that the information entered above is true and correct and was entered by myself.
Submission Date*

DayMonthYear
Should be Empty: