Club:	ACN:
Player Name:	Agreement dated:
Commencement Date:	Expiry Date:
Total payments to date (this year), excluding medical costs (Gross):	$
Agreed Total settlement for remainder of contract (Gross):	$
Less total deductions (super, tax, etc.):	$
Net amount due:	$
Payment date 1:	Net amount due:	$
Payment date 2:	Net amount due:	$
Other settlement details (e.g. any injury remediation plans and payment agreements):
The club, the player and the agent (if applicable) agree to the above Termination / Release details as full and final settlement of the NSWRL Playing Contract detailed above. All parties agree that they are released from all obligations, rights and responsibilities under the above noted Agreement as of the below date, subject to the final payments. All parties agree there are no further details of Termination / Release which were agreed and require noting.
This deed to be enacted this day of , 201 .
SIGNED for and on behalf of the club: Club Representative (print name) Club Representative (signature) Witness (signature) SIGNED by the player: Player (print name) Player (signature) Witness (signature) SIGNED by the agent (if applicable): Agent (print name) Agent (signature) Witness (signature) A signed copy to be kept by the player and club. The club is required to submit via email, within 5 business days, a signed copy to the NSW Rugby League.

Note: Agreement date, commencement date and expiry date can be found on Page 22 of the NSWRL Playing Contract.