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                  RUGBYLEAGUE 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 : ………………………………………………………………………………………………….

 

………………………………………………………………………………………………………………………….

 

 Print the form from here CRL Clearance Form