Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.PART A: TYPE OF COMPLAINTBreach of:National Community Football Policy HandbookOther AFL Policy (state which Policy)Reportable Offence under 22.2.2 of the Laws of Australian FootballVilification or Discrimination ComplaintBreach by:PlayerCoachFootball OfficialParent / SpectatorUmpireClubOtherIf ‘other’, rolePART B: OFFENDING PARTY (person or club who is alleged to have committed the breach)Person’s Name (if known) *Club NameIf person’s name is unknown provide any identifying information (eg jersey number, description of person, clothing worn etc)PART C: BREACH DETAILS (details of the incident or event)Date and time of incidentIf more than one incident, detail date and time of each.Where did the incident occur? A Match Other Event Online Which QuarterHome TeamGradeTime of QuarterAway TeamVenue AddressEvent DescriptionEvent AddressPlatform UsedPage / Site URLWhat occurred?Provide as much detail of -any relevant background information including anything leading up to the incident, -exactly what happened, was observed or was said or was posted -duration of the incident -anyone else involved in the incident -if during a match, what teams were playing & in what grade If multiple incidents, provide as much detail of each as possibleWho was the matter initially reported to, when and what action, if any, was taken?E.g. was it reported to the Ground Manager or an Official of the offending persons club and what actions did they take or say they would take? PART D: SUPPORTING EVIDENCE (attach all evidence that supports the complaint)Witness statements attached?YesNoBrief summary who each statement is from, their role in the event, date of statement, contact details.Other witnesses?YesNoDetail the name and contact details of any witness, other than those who have already made a statement.Brief summary Brief summary Film or images of incident attachedYesNoIf film attached, detail the time in the film the incident occurred (e.g. at the 16.27 minute mark).Other YesNoDetails of what this is, e.g. screen prints of social media postsBrief summaryBrief summaryAny other information you wish to provide that may be relevant to investigation and resolution of the complaint.Attach All Evidence * Click or drag files to this area to upload. You can upload up to 20 files. PART E: DECLARATION (of person lodging the Notice of Complaint) Your Name *Your Club *Your Email *Your Phone *Your RoleSignature Clear Signature Date / Time If under the age of 18If under the age of 18 Clear Signature Signature DateDateSubmit
