________
________

For the attention of: ________
________
________
________

________

Dear ________,

RE: Appeal Against Disciplinary Decision — Private and Confidential

Employee Name: ________
Job Title: ________
Department: ________
Payroll/Employee Reference: ________

1. I write to formally appeal against the disciplinary decision communicated to me by ________ at the disciplinary outcome meeting held on ________, and as confirmed in writing in the disciplinary outcome letter dated ________.

2. I submit this appeal in accordance with the appeals procedure set out in the Company's disciplinary policy and in accordance with my right of appeal under the ACAS Code of Practice on Disciplinary and Grievance Procedures.

3. The disciplinary sanction imposed upon me was as follows:

________

4. The disciplinary decision was issued in respect of the following alleged conduct or matters:

________

5. I appeal against this decision on the following grounds:

________

6. In particular, I consider that the sanction imposed was disproportionate and/or unfair, and/or that the disciplinary process was procedurally flawed, for the following reasons:

________

7. In support of my appeal I intend to rely upon the following evidence and/or documents, copies of which are enclosed or will be made available at the appeal hearing:

________

8. The outcome I am seeking by way of this appeal is:

________

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10. I confirm that I wish to exercise my statutory right under section 10 of the Employment Relations Act 1999 to be accompanied at the appeal hearing by a fellow worker or a trade union representative. I intend to be accompanied by ________.

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12. I would be grateful if you would acknowledge receipt of this letter and respond without unreasonable delay. I trust this matter can be dealt with fairly and promptly, and I thank you for your cooperation and understanding.

Yours sincerely,

________
Signature: ________
Date: ________

Enclosures: ________