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Notice of Appeal
Rev 08/03
Notice of Appeal
In the Victims Compensation Tribunal
SYDNEY, New South Wales
Claim Number ……….……………………………………………….…
(Victims Compensation Tribunal Claim Number)
Appellant …………………………………………………………………
(Applicant’s Name)
Postal Address……………………………………………………………
Solicitor Name/Firm…………………………………………………..…
(Only complete if solicitor is representing you for this appeal)
GROUNDS OF APPEAL
The appellant appeals to the Tribunal against the determination of the Compensation Assessor made on the……………………….., on the following grounds:-
1.
2.
3.
FULL PARTICULARS
1.
2.
3.The appellant relies on the attached particulars to support the appeal. Details establishing the grounds of your appeal should be attached to this Notice of Appeal. The particulars should be numbered and clearly marked as to which ground of appeal they refer.
Dated this ………………… day of …………………………, 2 .
Signed ……………………………………………………………………
(Notice of Appeal can be signed by either the appellant or the legal representative)
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