Code Breach Allegation Form

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Please note: Before completing this form, please read “Guide to Making a Complaint” that can be found here. This will also provide guidance and information to help you complete this form.

Complainants must hold a current Club Membership for the Club detailed in this complaint. Any complaints received from non-members or anonymously (or any request by a complainant for his/her name not to be shared with the Club) are unfortunately unable to be considered.

Any queries regarding the completion of this form may be directed to [email protected].

Start date of incident

Club

Are you a member of this club?

Yes

Member Number

First Name

Last Name

Address

Phone

Nature of alleged Code breach

Identify below the specific and relevant section(s) of the code that you allege have been breached by the Club.

Details of alleged breach

Explain below how the Club breached the Code. Provide clear, relevant and concise detail of the incident, preferably in dot points and in chronological order. Also please provide a reference here to any relevant documents that you have attached to this form.

What was the result of efforts to resolve the matter directly with the Club?

Detail below

Attach Copies below of RELEVANT documents such as correspondence from the Club and other documents that support your allegation.

Please clearly LABEL all the attachments and provide them in chronological order (by date/event). Information that is not relevant to the alleged breach will not be considered.

Upload requirements

Maximum File Size for attachments 5MB

What outcome are you seeking in this matter?

Before completing your response, please review the enforcement provisions outlined in the Club Governance Code of Practice

Have you made a complaint about the Club to another organisation or a government agency, in relation to the allegations in this complaint, OR is legal action pending in relation to the allegations in this complaint?

Yes

If yes, please provide details below

By submitting this form, you acknowledge that you have read and agree to comply with the Club Governance Code of Practice. For information about how we collect, use and manage personal information, please refer to the Privacy Policy and Collection Notice.*

By submitting this form, I acknowledge and accept that, as the Code Authority meetings are held on a quarterly basis, this matter may take up to six (6) months or more to be determined and finalised.*

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Code Breach Allegation Form

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