JOHOR RUGBY UNION

MATCH OFFICIAL ABUSE REPORT

TO BE COMPLETED AND RETURNED TO YOUR SOCIETY

Person(s) responsible for abuse: NO 19

Club (if known): BP JOKERS

Please indicate: Player / Coach ☐ Club official ☐ Spectator ☐

Fixture:
Home team UTHM Team Select
Away team BP JOKERS Team Select

Date of incident: 14/10/2017 Match venue: UTHM

Was a match video made? Select Competition title: JOHOR RUGBY LEAGUE

Officials Name Email Address Telephone Society

Referee Abdul Barr Click here to enter text. Enter tel. Enter text.
A/R 1 MOHD RIDHUAN Click here to enter text. Enter tel. Enter text.
A/R 2 BUDI SUFFIAN Click here to enter text. Enter tel. Enter text.

List names and club of any witnesses to the incident who may be prepared to submit a statement and give
evidence at any hearing if required:
MOHD RIDHUAN(AR 1), BUDI SUFFIAN (AR 2), WAK BIRIN

Nature of abuse: Physical / Verbal Other ☐ (Please indicate):

Click here to enter text.

Detailed report of incident (continue on next page if necessary):

SITUASI BERLAKU PADA MINIT KE 79 SEMASA RUCKING SECARA TIBA-TIBA DARI ARAH BELAKANG PEMAIN
NO 19 DARI BP JOKERS TELAH MEMBUAT FLYING KICK TERHADAP PEMAIN UTHM DI HADAPAN SAYA. SETELAH
MENDAPAT PENJELASAN DAN BANTUAN DARI AR 1 SAYA IAITU MOHD RIDHUAN.KAMI BERSETUJU UNTUK
MENGHADIAHKAN PEMAIN NO 19 DENGAN KAD MERAH.
 JOHOR RUGBY UNION
MATCH OFFICIAL ABUSE REPORT
Detailed report of incident continued:
Click here to enter text.

Signature of Referee Click here to enter Referee signature Date Click here to enter a date

Signature of Asst. Referee Click here to enter A/R signature Date Click here to enter a date
(WHERE APPLICABLE)