Rugby League Clearance Certificate - Free Download
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Rugby League Clearance Certificate
Rugby League Clearance Certificate
RUGBY LEAGUE CLEARANCE CERTIFICATE
To be completed by the Player of Club Office Reference No :…….………..
Player’s Name (print) : ………………….……………………..…………Date of Birth : ……..….……………..
Address : …………….……………………………………………………………………….………….……………….
Request Clearance from : ……………….…………………………RLFC in the following division/club/
district or group : …………………………………….
Year player last played : ………………to play with the: ………………………….………….Club in the
following division/club/district or group : ……………………….……in the state/Country of …….…
Player’s signature : ……………….…………………………….….……………Date : …………..……………….
This form must be sent to the Secretary of the Club from whom the player wishes a
Clearance. After being cleared by the Club, this certificate should be forwarded to the
relevant League.
Playing Details : Nominate player’s highest level in the last two seasons.
Senior : …………….…………………………………………………………………..…Year : ……….…………..
Junior : …………….…………………………………………………………………..…Year : ……….…………..
School : …………….…………………………………………………………………..…Year : ……….…………..
Name of Club/Group/State/Country :………………………………………………………………………….
Authorised by (signature)………………………………………………………Date :…………………………..
Group and/or District : ………………………………………………………………..…………………………..
Division/Country League : ………………………………………………………………………………………..
State League : ………………………………………………………………………………………………………..
National League :…………………………………………………………………………………………………….
Development Fees on Clearance : $………+ GST….. Amount due on NRL Debut : $……+GST….
Notes : ……………………………………………………………………………………………………………………
Special Conditions : …………….…………………………………………………………………..………........
…………………………………………………………………………………………………………………………..
Judiciary Report : ………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
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