| SAINT LUCIA |
| BETWEEN: |
| Appellant |
| And |
| Respondent |
| NOTICE OF APPEAL |
| Take notice that (1) , a health practitioner /an |
| applicant for registration under the Act who is aggrieved by the decision of the relevant Council, |
| (2) |
| dated 20 of which he/she received notice |
| on the day of 20 that |
| (3) |
| |
| |
| |
| hereby appeals to the Appeals Board for the reasons set out in paragraph 5 below and will at the hearing of the appeal seek a decision to the Appeals Board that |
| (4) |
| |
| |
| Reasons for Appeal |
| (Insert FULLY here the reasons for the Appeal) |
| (a) |
| (b) |
| (c) |
| All notices or other documents relating to this appeal may be sent to the Appellant at |
| (5) |
| |
| Dated this day of 20 |
| |
| Appellant/Legal practitioner |
| To: | The Secretary |
| The Appeals Board |
| Note: |
| (1) Name of appellant |
| (2) Relevant Council |
| (3) Insert substance of the decision appealed against |
| (4) State decision sought from the Appeals Board |
| (5) Address |