Response to Appeal Application
| Published date | 21 March 2018 |
| Subject Matter | Primary 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 oce use only
Oce 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 oce.
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
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