Application For Clearance To Play In Another Union Form - World Rugby printable pdf download

WORLD RUGBY

APPLICATION FOR CLEARANCE TO PLAY IN ANOTHER UNION

CURRENT UNION: ______________________________________________

APPLICANT’S NAME: ________________________________Date of Birth: ____/___/_______

Name of current club or other rugby organisation: _______________________________________

In which country do you propose playing Rugby? ___________________________________________

Name of Proposed Club: ________________________________________________________________

Proposed date of Departure from Current Union: ___________________________________________

Anticipated date of return to Current Union: _______________________________________________

Are you currently under contract with a Club, Union or Rugby Body for the provision of Material Benefit for your

participation in the Game? If so, please state when this will come to an end and supply a copy of the contract. __________

In the preceding 12 months the Player has obtained the following period of rest:

________ days – rest from any Match(es) and/or team training.

_________ weeks and

________ days – rest from any Match participation (excluding periods of injury)

_________ weeks and

Date & opponents of Last match played:

________________________

PLAYER DECLARATION

I,_________________________________________________________________________________

(Applicant’s full name – Forenames first)

of:________________________________________________________________________________

declare that the above information is correct and I understand that on leaving my Union I will be required to

submit a similar application before I can be permitted to play in another union.

Applicant’s signature

____________________________________

____/___/______

Date:

DECLARATION ON BEHALF OF CLUB

The applicant is in good standing with this Club and has no financial debt to this Club.

____/___/______

Authorisation Signature of Club Official _________________________________Date:

Print Name ________________________________________ Position________________________________

DECLARATION ON BEHALF OF UNION

The applicant is in good standing with his Club and his Union. He is in no financial debt to his Club or this Union. He is

under no playing suspension order within the jurisdiction of his Union. At the time of this approval, the player is/ is not

(delete as appropriate) under contract for Material Benefit for his participation in the Game.

Union

Union Stamp:

Signature:

(& Date)

_________________________________

If this declaration is signed by an official of a Union other than the Secretary of the National Union, it must be sent for approval by the Secretary of the

National Union. Original: To be retained by Current Union Copy: One to the person concerned and another to be sent to the Secretary of the proposed

new Union.

Application For Clearance To Play In Another Union Form - World Rugby

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