NOTICE OF RESPONSE

NOTICE OF RESPONSE (SECTION 8.2)
Prescribed Form 12
MEMBER DETAILS
Full Name*

First NameLast Name
FFA or DRIBL Number*
Club Name*
NOTICE DETAILS
Date of Notice of Charge*

DayMonthYear
Reference Number*
PLEA ENTRY
Charge 1: Please tick your chosen option*

I am pleading GUILTY to the charge and I accept the report(s) attached to the Notice of Charge.I am pleading GUILTY to the charge but I do not accept the report(s) attached to the Notice of ChargeI am pleading NOT GUILTY to the charge.
Charge 2: Please tick your chosen option

I am pleading GUILTY to the charge and I accept the report(s) attached to the Notice of Charge.I am pleading GUILTY to the charge but I do not accept the report(s) attached to the Notice of ChargeI am pleading NOT GUILTY to the charge.
Charge 3: Please tick your chosen option

I am pleading GUILTY to the charge and I accept the report(s) attached to the Notice of Charge.I am pleading GUILTY to the charge but I do not accept the report(s) attached to the Notice of ChargeI am pleading NOT GUILTY to the charge.
Charge 4: Please tick your chosen option

I am pleading GUILTY to the charge and I accept the report(s) attached to the Notice of Charge.I am pleading GUILTY to the charge but I do not accept the report(s) attached to the Notice of ChargeI am pleading NOT GUILTY to the charge.
Charge 5: Please tick your chosen option

I am pleading GUILTY to the charge and I accept the report(s) attached to the Notice of Charge.I am pleading GUILTY to the charge but I do not accept the report(s) attached to the Notice of ChargeI am pleading NOT GUILTY to the charge.
DOCUMENTS TO SUPPORT YOUR CHOSEN ACTION
Please upload any written submissions that you wish the Disciplinary Tribunal to consider when determining any sanction that may be imposed.

Upload a File
You may upload multiple files. Only PDF, DOC and DOCX files accepted. Max. file size 4MB Cancelof
REPRESENTATION

If you are under the age of 18, you must be accompanied by your parent/guardian
Do you wish to be represented by a support person of the Club / Association?*

YesNo
Please provide name and contact details of Club / Association representative
Do you wish to be supported by a lawyer?*

YesNo
Please provide name and contact details of the legal representative
Notes:

1. Please submit this form by the date referred to in the Notice of Charge.

2. Unless there is a reasonable excuse, if FC does not receive a properly completed Notice of Response by the time specified in paragraph 1 above, you are deemed to have pleaded guilty to the charge(s) set out in the Notice of Charge and accept the reports attached to the Notice of Charge.

3. Participants should read and consider section 8.2 (Charges of Misconduct and Disrepute) and section 12 (Administrative Procedures of Tribunals) prior submitting this Notice of Response to FC.

4. Capitalised words used in this document are defined in the Regulations.
SUBMISSION
Your name*

First NameLast Name
E-mail Address*
A copy of your submission will be emailed to this address.
Digital Signature*

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

DayMonthYear
Should be Empty: