Part 1 – Name of Inquiry

Name of Inquiry *

Part 2 – About the Submitter

Title or Rank *

Given Names *

Surname *

Post-nominals (if applicable)

Street Number and Name *

Suburb *

Postcode *

State *

Email Address: *

Primary Contact Number *

Secondary Contact Number

Is the Submission on behalf of an organisation? If yes, please provide details:

Part 3 – Desired outcome

Provide a summary of your submission:

Part 4 - Your submission and Supporting Documentation

Part 5 – Consent and declaration

✔

✔ I also consent to the Defence Honours and Awards Appeals Tribunal:

• using information contained in my submission to conduct research;
• providing a copy of my submission to a person or organisation considered by the Tribunal to be appropriate; and
• providing a copy of my submission to a person or organisation the subject of adverse comment in the submission;
• using content in my submission in its report to Government.

The Tribunal will decide which person or organisation is appropriate, and this may include:

1. persons or organisations required to assist with the inquiry; and
2. persons or organisations with an interest in the inquiry.

✔ I declare that the information I have provided is correct.

Name

Date