Application for clearance to play with another Club within the same Union
Name: ____________________________ _____________________________
(Surname)
(Forenames)
Current Club: ___________________________________________________
ARU Reg. No: __________________ New Club: _______________________
Are you currently under contract with any club, Union or Rugby Body for the provision of material
benefit for your participation in the game? If so, please supply a copy of the contract.
Yes (copy attached)
No
DECLARATION: (Applicant’s full name) _____________________________
(Applicant’s full address)
_________________________________________
_________________________________________
Phone: _______________________
I declare that the above information is correct.
Applicant’s signature: _______________________ Date: _______________
DECLARATION on behalf of the current club:
The applicant is a registered player and is not under suspension from this club. We have no
objection to the applicant leaving this club as of ___/ ___/ ___
On behalf of ____________________ Rugby Club
_____________________________________ ____________________
(Date)
(Name)
(Signature)
Or
We object to the provision of a clearance for the following reasons: (See attached)
On behalf of ____________________ Rugby Club
_____________________________________ ____________________
(Date)
(Name)
(Signature)
ACCEPTANCE by new club
_____________________________________ ___________________
(Date)
UNION APPROVAL
(Name)
YES
(Signature)
NO
________ ________________________ ____________________
(Name)
(Signature)
(Date) ____