Complaint Form

Allegations
Date/s of alleged breach/es by Respondent*
Location/s of alleged breach/es by Respondent
Description of alleged breach/es by Respondent

Please provide as much information as possible, including details of;
- Who is involved
- What happened
- When & How you found out about the alleged breach
Further Evidence
Where applicable, please provide any additional evidence (pictures, videos etc.) to support your complaint.

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Witnesses

(if any)
Did anyone else witness the alleged breach/es by the Respondent?

YesNoNot Sure
If 'yes' please list the witnesses and their contact details (if known):
First Name   Last Name
Phone Number
Email

First Name   Last Name
Phone Number
Email

First Name   Last Name
Phone Number
Email
Level of Sport
At what level of Equestrian did the alleged breach occur?*

Equestrian Australia, National (NSO) Level. Where behaviour, an incident or circumstances that occurred at or involved individuals operating at EA level.State Branch (SSO) Level. Where behaviour, an incident or circumstances that occurred at or involved individuals operating at the State (Territory) level.Club Level. Where behaviour, an incident or circumstances that occurred at or involved individuals operating at the Club level.
Policy
Please outline the eligible policy and sections of the policy that the Respondent has allegedly breached.*

Consent
Do you the Complainant consent to alternative dispute resolution (e.g. Mediation) if required?

YesNo
Signature*

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Date*

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Respondent