NSFA Intention to Challenge Form

Intention to Challenge Form

Prescribed form to lodge an intention to challenge under section 4.7.2A of the Competition Regulations 4. Grievance and Discipline ("Regulations")
Your Details

Details of the person submitting the form
Full Name*
Email*
example@example.com
What is your involvement in the matter?*

I am the person who was sanctionedI am a representative of the person, club or affiliated body who was sanctionedI am a NSFRA representative who is challenging a sanction given for a matter involving misconduct towards a Match OfficialI am the person, or the representative of the person, who made the complaint from which this matter arose
Sanction Details

Details of the sanction which is being challenged
Matter Number*
Offence Code and Grading*
Sanction Imposed*
Reported Person Details

Details of the person who committed the offence
Name*
Member ID Number*
Grounds for Challenge

Indicative basis for challenging
To facilitate the appropriate timetabling and resourcing of PD&DC matters, could you provide an initial overview of the reasons you are challenging the initial sanction. You will not be bound by anything you include in this section. Anything you include is indicative only and you are free to make different submissions in the hearing should you wish.
Please provide a high level overview of the basis on which you are challenging the initial sanction.
Video and Audio Evidence
Pursuant to section 4.10.1(c) of the Regulations, if a Club is in possession of (or has access to) any video / audio evidence that is relevant to the matter, it must, at the same time as lodging the Intention to Challenge, provide such evidence to NSFA Ltd in the manner or form requested.

A party must not withhold or fail to provide video / audio evidence that is in its
possession (or it has access to) that may be inconsistent with the position taken
by the party (including by only providing a sub-set of available video / audio
recordings of an event).
Please attach any video / audio materials you intend to rely on here.

Browse Files
Max 20MB. If the file is greater than 20MB, please contact the NSFA to determine the appropriate way to provide the evidence. Cancelof
Acknowledgements
Not time barred: I confirm that I am lodging this intention to challenge by 5pm on the 3rd working day after the Club was notified of the sanction.*

YesNo
Payment of challenge fee: I have paid a challenge fee of $200 to the NSFA by direct deposit into NSFA’s bank account using the matter number as a reference. (Please confirm bank account details with your Club Treasurer)*

YesNo
Please attach payment remittance:

Browse Files
Max 20MB. If the file is greater than 20MB, please contact the NSFA to determine the appropriate way to provide the evidence. Cancelof
By submitting this form, I acknowledge that:
1. If this is a valid intention to challenge, the PD&DC will reconsider the matter in its entirety and has discretion to make whatever determination it is empowered to under the Regulations, including a determination of a higher sanction.
2. Until the PD&DC makes a decision, the Initial Sanction continues to apply unless the PD&DC makes an interim determination to the contrary.
3. I may abandon a challenge prior to any hearing by giving notice to NSFA and the NSFA may, in their absolute discretion, refund the challenge fee.
4. A party seeking to rely on written evidence (including statements and submissions) at a hearing of the PD&DC should endeavour to provide such evidence no later than by Close of Business the day before the scheduled hearing. Failure to do so may lead to the evidence being inadmissible.
Should be Empty:

Intention to Challenge Form

Your Details

Sanction Details

Reported Person Details

Grounds for Challenge

Video and Audio Evidence

Acknowledgements