IRISH RUGBY UNION World Rugby CLEARANCE

Please type into all applicable fields

1. Name of Player “Player” DOB Surname Forename

Player ID# Current Address of Player

2. Name of Union and Club with which the Player is registered currently

National Union

Club 3. Name of Union for which the Player is eligible to play in International Matches

4. Highest level at which the Player has played whilst Registered in Current Union

[e.g. International / Representative (state level), Club or other Rugby playing organisation (state level)]

5. Union and Club proposed to Register and play (“New Union”)

National Union Club

6. If the Player is a Contract Player, the date on which their written agreement within their current Union came / will come to an end (A copy of the Player’s current / most recent contract must be attached to this Clearance)

7. In preceding 12 months the contract player has obtained the following period of rest:

weeks and days –rest from matches and/or team training weeks and days –rest from any match participation (excluding periods of injury

8. The date of the Contract Player’s last match was: Teams v

9. Player Name:

Player Signature: DECLARATION OF CURRENT UNION

1. The information set out above is true and correct in every respect. 2. The Player is not currently under suspension on disciplinary grounds (which, for the avoidance of doubt, shall include any Doping Offence) for a period of more than five weeks. The New Union has agreed that any current suspension of the Player shall apply to matches played under its jurisdiction. 3. If the Player is a Contract Player, the Player has no outstanding obligations under the terms of their written agreement with their Union, Rugby Body or Club.

Signed by Print Name

An authorised signatory on behalf of Dated Name of Current Club

Signed by Print Name

An authorised signatory on behalf of Dated Name of Current Union

Acknowledged and agreed by Print Name

An authorised signatory on behalf of Dated Name of New Union

Acknowledged and agreed by Print Name

An authorised signatory on behalf of Dated Name of Union for whom the Player is eligible to play international matches ( If different to Current or New Union)

Regardless of the signature and dating of this Clearance, this Clearance shall only become effective when:-

(i) the New Union has received an original version (or a facsimile copy of the original version) of the Clearance; (ii) the Player’s written agreement with his Current Union has expired or been terminated; and (iii) the Player’s Registration within his Current Union has been cancelled.

Data Protection Statement: I understand that it is necessary for the Irish Union (IRFU) to collect and record the personal data on this form (“Personal Data”) for the contractual purpose of registering me with the IRFU or another Union. I understand that my Personal Data may be shared with the Provincial Branch, the IRFU, another Union and that all are Data Controllers. When transferring to the IRFU I understand that my personal data may be disclosed to other stakeholders of our association and third parties for the purposes of inviting me to events and meetings, to facilitate me playing or coaching matches, to promote and enhance the IRFU brand, to develop the game of rugby and to comply with any applicable legal obligations. I understand that my Personal Data will be retained by the Branch and the IRFU for the duration of my contract and in line with their respective Retention Policies. I further understand that I have a number of rights around the processing of Personal Data, including the right to request in writing a copy of my Personal Data which the Branch or IRFU holds, amend any information which is incorrect and to apply to have my Personal Data erased. I can also confirm that I have been given the opportunity to consult further relevant information concerning my data protection rights at www.dataprotection.ie. I am aware of all my Data Protection rights and have given my consent for my personal data to be processed by signing this form.