Prescribed Form 3- Player Eligibility

Protest

Club Submitting Protest

Club
Name of Club Official Position
Contact Number Email
Date of Request

Fixture Details

Date Time
Clubs
Competition Grade/Age

Grounds for Protest (Attach additional papers if necessary)

Acknowledgement
In lodging this request, the Club acknowledges that:
 The Protest has been lodged within 72 hours of the completion of the Match;
 Payment of the Protest fee has been paid to Football West and will only be refunded if the Protest is
proven; and
 No request will be accepted if the Club has a debt owing to Football West which is older than 30
days.

Lodgement
This form must be lodged by either the President or Secretary of the club via Email. A form lodged by any
other person will not be accepted unless:
a) the club can demonstrate exceptional circumstances exist and approval has been received in
writing by Football West; or
b) if it bears the name and signature of the President or Secretary below.

President/Secretary: ______________ Signature: ______________________________________

Prescribed Form 3: Player Eligibility Protest