Application to change of Federation of Origin

Application to change of Federation of Origin
Demande de changement de Fédération d’Origine
Player/ Joueur
Last name / Nom
First name / Prénom
Place of birth / Lieu de naissance
Date of birth D-M-Y/ Date de naissance J-M-A
(photo)
Nationality/ Nationalité
Passport N° New Federation of Origin/
N° de Passeport Nouvelle Fédération d’Origine
Have you played for the National Team of your Current Federation of Origin? YES
NO
Avez-vous joué pour l’équipe nationale de votre Fédération d’Origine actuelle ?
I, the undersigned, agree to the FIVB regulations, I am only permitted to change the Federation of Origin once
and may not change back to the Original Federation of Origin or to a third Federation of Origin.
Sex / Sexe
Je, soussigné, déclare être d’accord de ne changer de Fédération d’Origine qu’une seule fois et de ne pas pouvoir
revenir à la première Fédération d’Origine ni changer pour une troisième Fédération d’Origine, selon les règlements
de la FIVB.
Women / Femme
Men / Homme
Player’s signature / Signature du joueur
Current Federation of Origin / Fédération d’Origine Actuelle
Approved / Approuvé
_
Name of the National Federation / Nom de la Fédération Nationale
* Not approved / Non approuvé
Name of the president / Nom du Président
Seal and Signature / Sceau et Signature
* Please, attach statement if not approved / * S’il vous plait, veuillez nous envoyer une déclaration en cas de non approbation.
New Federation of Origin / Nouvelle Fédération d’Origine
Approved / Approuvé
_
Name of the National Federation / Nom de la Fédération Nationale
* Not approved / Non approuvé
Name of the president / Nom du Président
Seal and Signature / Sceau et Signature
* Please, attach statement if not approved / * S’il vous plait, veuillez nous envoyer une déclaration en cas de non approbation.
FIVB
Date received / Reçu le
will take effect on / en vigueur le
Approved / Approuvé
* Not approved / Non approuvé
_
President’s Signature / Signature du Président
General Director / Directeur Général
► Proof of payment of the Administrative Fee to the FIVB
► Six (6) original copies must be sent to the FIVB. No color copies or emails will be accepted./ Six (6) copies originales doivent être envoyées à la FIVB. Les copies
couleur et courriers électroniques ne seront pas acceptés.
► Copy of the passport of the new nationality / Copie du passeport de la nouvelle nationalité.
► Proof of residence for 2 years / Attestation de résidence depuis 2 ans.
For FIVB use only / Pour usage interne
Player FIVB N˚ / N˚ joueur FIVB

Payment / Paiement

Date
FEDERATION INTERNATIONALE DE VOLLEYBALL
Edouard-Sandoz 2-4, 1006 Lausanne – SWITZERLAND Tel : +41 (21) 345 3535 Fax : +41 (21) 345 3545 www.fivb.org
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Application to Change of Federation of Origin
Candidature pour changement de Fédération d’Origine
PLAYER PERSONAL DATA
Family Name:
First Name:
Previous Family Name (if applicable):
Date of Birth:
Place of Birth (City/ Country):
Passport # and date of Issue – Country of Previous Federation:
Passport # and date of Issue – Country of New Federation:
VOLLEYBALL HISTORY
TO BE COMPLETED BY THE FIRST FEDERATION OF ORIGIN
In which country did the player have the first Volleyball license?
What year?
In which country did the player have the last Volleyball license?
What year?
If the player has had more than one Federation, please explain why:
Has the player had an International Transfer Certificate (ITC)?: Yes 
No 
If yes, please provide: FIVB Player Number
/ at least the last two (2) ITCs n°:
/
 Has the player played for the National Team of the First Federation?:
If yes, at what level:
Youth 
Junior 
Senior 
If yes, last tournament, level and year in the National Team:
Yes 
No 
All 
Not Applicable 
World Comp.  Continental Comp.  FIVB Comp.  Other  If other, which:
/ Junior 
Youth 
Senior 
/ Year:
Please add any other Personal Volleyball History deemed relevant:
NEW FEDERATION MEMBERSHIP
Since when and where has the player been living in the country of the New Federation?
We understand that once the player has changed Federation of Origin, there may be no change back
to the First Federation of Origin or to a third Federation of Origin.
We are aware and agree with the terms and provisions of the Article 5. “Change of Federation of
Origin” of the FIVB Sports Regulations mentioned in the next page of this application form.
Players Signature
Previous NF Signature and Stamp New NF President Signature and stamp
FEDERATION INTERNATIONALE DE VOLLEYBALL
Edouard-Sandoz 2-4, 1006 Lausanne – SWITZERLAND Tel : +41 (21) 345 3535 Fax : +41 (21) 345 3545 www.fivb.org
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Application to Change of Federation of Origin
Demande de changement de Fédération d’Origine
ARTICLE 5 FIVB SPORTS REGULATIONS
5.1
A player's Federation of Origin may be changed only once. Changes of Federation of Origin may be
approved only by the FIVB Executive Committee upon proposal of the FIVB President.
5.2
5.2.1
5.3
5.3.1
5.3.2
CONDITIONS
A change of Federation of Origin (hereinafter "the Change") may be approved only if the following
conditions are cumulatively met:
5.2.2
5.2.3
5.2.4
5.2.5
GENERAL
5.4
The player has established residence in the country of his new Federation of Origin (hereinafter
"the new Federation") for a minimum of two (2) continuous years immediately prior to the time of
filing the application for the Change.
The player has obtained the nationality of the country of the new Federation.
The player's Federation of Origin agrees to the Change.
The new Federation agrees to the Change.
The applicable administration fee for the Change has been paid to the FIVB (see Article 5.3.2
below).
PROCEDURE
The following documents shall be submitted to the FIVB:
a) 6 original copies of the respective FIVB form (see www.fivb.org), duly signed and stamped
by the player, his Federation of Origin and the new Federation; and
b) Proof of two (2) years continuous residence in the country of the new Federation; and
c) Copy of the player’s International Passport of the country of the new Federation.
The administrative fee for a Change is CHF 15,000. If the player has played for a senior national
team, the applicable administrative fee is CHF 25,000.
SPECIAL CASES
5.4.1
In case the player has never played for any national team and had already at birth the nationality
of the country of the new Federation, the FIVB may approve the Change as follows:
a) The conditions of Article 5.2 shall be met, except for the condition of 2-year continuous
residence.
b) The documents mentioned under Article 5.3.1.a and 5.3.1.c above shall be submitted to FIVB,
along with proof of when the player acquired the nationality of the country of the new Federation.
c) The applicable administration fee is CHF 2,000.
d) The National Federations involved and the FIVB may agree that the Player’s transfers between
the two National Federations will be exempted from the payment of administration and transfer
fees.
5.4.2
In case
a) the player has established residence in the country of the new Federation for a minimum of
eight (8) continuous years; and
b) the application for a Change is filed with the FIVB on or after the 1st of January of the
calendar year during which the player turns 38 (for men) or 35 (for women); and
c) the conditions of Article 5.2.2 (nationality) as well as Articles 5.2.3 and 5.2.4 (agreement of two
National Federations) are met,
the condition of Article 5.2.5 (administration fee) shall be waived.
FEDERATION INTERNATIONAL DE VOLLEYBALL
Edouard-Sandoz 2-4,1006 Lausanne, Switzerland • Tel: +41 21 345 35 35 Fax : +41 21 345 35 45 / [email protected]
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Application to Change of Federation of Origin
Demande de changement de Fédération d’Origine
ARTICLE 5 FIVB SPORTS REGULATIONS
5.5
CONSEQUENCES
5.5.1
Unless decided otherwise, the decision of the FIVB Executive Committee to approve the Change
is effective from the day of its notification to the new Federation.
5.5.2
As of that date, the player shall have the same rights and obligations with players of the new
Federation (e.g. he can directly compete in club competitions of the new Federation without a need
for ITC). However, if the player has previously played for another national team, he will be
eligible to play for a national team of the new Federation only after two (2) years have elapsed.
This two-year period starts from the day that the complete application file, containing all required
documents, is received by the FIVB.
FEE
Senior National Team Player?
Special Case?
Yes  Fee of CHF 25’000
Yes  Fee of CHF 2’000
No  Fee of CHF 15’000
INVOICE DATA
PLAYER NAME:
NEW FEDERATION:
ENTITY / PERSON RESPONSIBLE TO PAY THE FEE:
ADDRESS OF ENTITIY / PERSON:
DATE
NEW FEDERATION PRESIDENT SIGNATURE & STAMP OF APPROVAL
FEDERATION INTERNATIONAL DE VOLLEYBALL
Edouard-Sandoz 2-4,1006 Lausanne, Switzerland • Tel: +41 21 345 35 35 Fax : +41 21 345 35 45 / [email protected]
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