APPENDIX 3.             INTERNATIONAL PLAYER MOVEMENT COMPENSATION CLAIM FORM

1.                Player details:

Surname: ..............................................  Forename(s): .......................................

Address: ..................................................................................................................

...................................................................................................................................

.................................................................  Tel: ........................................................

Age: ........................................................  Date of Birth: .......................................

Current Union: .....................................  Home Union: .......................................

2.                Player's Union/Rugby Body/Club [please delete] completing this form ("the Claimant"):

Name: ......................................................................................................................

Address: ..................................................................................................................

...................................................................................................................................

.................................................................  Tel: ........................................................

Union: .....................................................................................................................

3.                Player Status:

(a)     Is the Player registered with his current Union?       Yes            No

(b)     Is the Player a registered Contract Player?             Yes            No

(c)     Is the Player a registered Non-Contract Player?      Yes            No

Date of registration with Union: ..........................................................................

Date of registration as a Contract Player: .........................................................

4.                Has the Player entered into a written agreement with a Union, Rugby Body or Club OUTSIDE HIS HOME UNION before?

Yes            No    

5.                State the amount of compensation claimed by the Claimant for the Player's training and/or development:

Amount: ..................................................................................................................

6.                In respect of your claim for compensation for this Player please provide a history of the Players career to date including the following information:

(a)     Proportion of salary(ies) or compensation paid to Coach(es):

...................................................................................................................................

...................................................................................................................................

(b)     Board and lodging:         

...................................................................................................................................

...................................................................................................................................

(c)     Proportion of travel costs to away matches:   

...................................................................................................................................

...................................................................................................................................

(d)     Proportion of cost of training and development infrastructure (eg. hire / construction of facilities/equipment):

...................................................................................................................................

...................................................................................................................................

(e)     Medical costs expended on the Player:          

...................................................................................................................................

...................................................................................................................................

(f)      Non-rugby related expenditure in respect of the Player provided by the Union, Rugby Body or Club, as the case may be, (for example schooling and academic expenses):           

...................................................................................................................................

...................................................................................................................................

(g)     Other general costs that can be attributed, either in full or in part, to the player's rugby education, training and development.[13]          

...................................................................................................................................

...................................................................................................................................

Please continue on a separate sheet if necessary.

7.                Please provide the following information:

(a)     Playing experience of the Player (e.g. National representative appearances of the Player at all age levels; senior appearances with the Claimant):  

...................................................................................................................................

...................................................................................................................................

(b)     Length of time the Player trained with the Claimant:           

...................................................................................................................................

...................................................................................................................................

Other (please state):    

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

Please continue on a separate sheet if necessary.

 

Declaration:

I am authorised on behalf of the Claimant to certify that the information contained in this form is correct.

I do so in the knowledge that the Claimant may be called upon by World Rugby to further justify and verify the information contained in this form and that any incorrect or misleading information will render the Claimant liable to sanction by World Rugby and/or the Claimant's Union.

 

Signed:

......................................................................................................................................................

(Signature)                                                                 (Print Name)

Official capacity:

....................................................................................  Date: .....................................................

 

[13]  Do not include expenses attributable to playing, training and development activities that formed part of the Player's general academic education.