NATIONAL PLAYER RUGBY ILLNESS/INJURY CLAIM

Medical information should be treated confidentially.
All reported claims will be contacted and followed up by the HKCR Player Welfare & Medical department within 1-2 working day(s).
This claim form is for HKCR National contracted player only.
The completed form should be returned to us with all supporting documents as soon as possible within 14 days from the date of service.

Player must deliver or post the original receipts to:

Hong Kong China Rugby – Medical Department 2/F, So Kon Po Recreation Ground 55 Caroline Hill Road, So Kon Po Causeway Bay, Hong Kong

Player name *

Squad *

Gender *

Date of Birth *

Contact Telephone

Contact Email *

Date of service *

Doctor/Clinic Visited *

State the currency and amount paid *

Reason for Visit *

Follow-up actions

Please provide the bank details below if they have not been provided before.

Bank Name

Account Holder Name

Account Number

Notes/comment

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