Participant Responsible – Mistaken Identity

Your Name*
First Last
Your Contact Email Address*
Club Name*
Position in Club*
Match Details
Opposition*
Age/Grade/Division*
Untitled
Match Date*
DD slash MM slash YYYY
Time of Kick-Off*
: Hours
Minutes
AM/PM
Venue*
Offence Reported*
Please Specify Other*
Declaration
I declare that there has been a case of mistaken identity to the above mentioned match.
I declare that the Participant referred to below was not responsible for the Offence reported by a Match Official.
I delcare that I:*
- Participated in the match above
- I was repsonsbile for the offence issued against the participant referred to below
Participant's Name*
First Last
FFA Number*
Participant Name*
First Last
FFA Number*
By checking the box below, I declare that:*
- 1. Consent to being issued with a Notice of Suspension instead of the Participant above
- 2. Declare that the information in this statement is accurate to the best of my knowledge
Acknowledgement*
- I acknowledge that I may be charged with Misconduct if it is established that contents of this statement are incorrect and amount to an abuse of process.

Match Details