Please complete in BLOCK CAPITALS, stating surname followed by first name of all players & replacements

AS THEY APPEAR ON THE OFFICIAL RFU PLAYER REGISTRATION COMPUTER LISTING.

N.B. YOU MUST IDENTIFY FRONT ROW REPLACEMENTS WITH A P IN THE FR COLUMN

home team

PTS

V

away team

PTS

No. of tries scored

 

 

NO. OF TRIES SCORED

 

Date:

 

Venue:

 

Attendance:

kick off time:

finish time:

 

FR

 

FR

15

 

 

15

 

 

14

 

 

14

 

 

13

 

 

13

 

 

12

 

 

12

 

 

11

 

 

11

 

 

10

 

 

10

 

 

9

 

 

9

 

 

1

 

 

1

 

 

2

 

 

2

 

 

3

 

 

3

 

 

4

 

 

4

 

 

5

 

 

5

 

 

6

 

 

6

 

 

7

 

 

7

 

 

8

 

 

8

 

 

 

THE BENCH

16

 

 

16

 

 

17

 

 

17

 

 

18

 

 

18

 

 

19

 

 

19

 

 

20

 

 

20

 

 

 

 

Min

Team

Colour

 R or Y

Players number and name

Reason for Card -  Please specify

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNCONTESTED SCRUMS     (TICK)     YES [    ]      NO [    ]   If Yes please provide details below

 

 

 

 

 

 

 

 

 

 

 

MATCH OFFICIALS           TECHNICAL AREA  ACCEPTABLE       (TICK)       YES [    ]      NO [    ]

If no give brief details:

 

 

Referee:

 

 

_________________________

Referee’s signature

Touch Judge 1:

 

Touch Judge 2:

 

 

 

Signed Home Official : ___________________

Print Name

Signed Away Official:____________________

Print Name

 

Home Team  

PTS

V

away team

PTS




SCORING SEQUENCE

Min

 

Score

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

:

 

 

 

KICKING RECORD         (PENS/CONS/DROPS)                                SUCCESS  a   MISS  r

Kicker

Team                                                    

1

2

3

4

5

6

7

8

9

10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALL REPLACEMENTS AND SUBSTITUTES USED  (INCLUIDNG BLOOD BINS)

Min

Team

Player Replaced [name and Number]

Replacement [name]

Reason

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THIS FULLY COMPLETED FORM MUST BE EMAILED OR FAXED NO LATER THAN 1 HOUR AFTER THE FINAL WHISTLE  TO: -

  NCA – Fax 0871 266 8334 or email ncarugby@btconnect.com.

THE FULLY COMPLETED ORIGINAL FORM MUST ARRIVE AT THE RFU BY FAX, EMAIL OR HARD COPY WITHIN 72 HOURS OF THE FINISH OF THE GAME – FAX 0208 831 7613 or EMAIL tombrewis@rfu.com.

Please note there is no longer any requirement to send results to Stephen McCormack or other persons