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Response to Appeal Application

Document Cited in Related
Vincent
Published date21 March 2018
Subject MatterPrimary Health Lists Tribunal forms
1
T173 - R esponse to appeal application fo rm (Primary Health Lists) (07.18) © Crown copyright 2018
A: Respondent’s details
B: Legal representative’s details
FIRST-TIER TRIBUNAL HEALTH, EDUCATION AND SOCIAL CARE CHAMBER (PRIMARY HEALTH LISTS)
Response to
Appeal application form
(Primary Health Lists)
AR For oce use only
Oce stamp (date received)
Case reference number:
Use this form to:
• Use this form to respond to an appeal application to the First-tier Tribunal (Primary Health Lists) in all cases.
• Tick the appropriate box or boxes and provide the relevant information for your appeal.
• Please complete by hand or on line using dark ink and then posted or faxed to the Primary Health Lists oce.
Alternatively, it can be sent electronically.
• Please write clearly.
Reference and/or
contact name
Address
Postcode
Telephone number(s)
(include any mobile)
Fax number
Email address
Please provide the following details:
All correspondence will be sent to your Representative should there be one. If not all documents will be sent to your
address above.
Solicitor’s name/
reference details
Address
Postcode
Telephone number(s)
(include any mobile)
Fax number
Email address
Reset form
Print form
Reset form
Print form

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