entry form - Historical Rally of Morocco

2016 May 9th to 14th
ENTRY FORM
IMPORTANT : Documents to be attached:
a) Fully fill in entry form (crew + car)
-remember to add your clothes’ size!
b) Copy of driver’s and co-driver’s passports
c) Copies of driver’s and co-driver’s national driving license
d) Copies of driver’s and co-driver’s currently valid International (ICCCC or
ICCCR) FIA licenses
e) Copy of the car insurance certificate
f) Fully fill in Custom’s form.
To easy the passing through the Moroccan customs (cars and servicing), please fill in and
return the table with mandatory information (to be found page 4) as soon as possible.
g)
!!! THE CUSTOMS MOROCCAN REQUIRES A BOOK ATA
Closing of entries : 2016 March 30th,
Send your completed entry to one of the following email :
[email protected]
[email protected] or [email protected]
Yves LOUBET : +33 (0) 612359199 ou +212 (0) 648866569 (Maroc)
Competitors relations : Marie France AGOSTINETTI : +33 (0) 6 08 67 35 77
Adress : Club des Sports Mécaniques "LE GRAND MAGHREB"
29 boulevard Abdelmoumen, quartier Tour Hassan
RABAT 10000-Maroc
Entry Free:
6 500 €
 Bank transfer : ASSO CSM GRAND MAGHREB
CREDIT DU MAROC agence RABAT 37 rue Abdelmoumen
IBAN : MA021810000006001562565984 CODE SWIFT : CDMAMAMC
www.rallyedumaroc-historique.com
Race N°
7th HISTORIC RALLY OF MOROCCO
2016 May 9th to 14th
CREW
Competitor
Driver
Codriver
Surname
First name
Nationality
Sex
Date and Place
of Birth
Address
ZIP Code
City - Country
Cell Phone
Email
Driving License
N°
Date and Place
of Issue
Passport N°
Expiry Date
FIA License N°
Code ASA/ASN
Clothes size
I declare acknowledging the entry conditions and agreeing on the terms and I certify that all
information here above provided is true
Signatures
Réservé à l’Organisation
Permis
pilote
Licence
pilote
Passeport
pilote
Permis
copilote
Licence
Copilote
Passeport
copilote
Attestation
assurance
Observations Vérifications Administratives :
Feuille
douane
Paiement
7th HISTORIC RALLY OF MOROCCO
2016 May 9th to 14th
VEHICLE
PERIOD
YEAR
BRAND :
TYPE :
Homologation
Form
N° and Date :
Car Plate N° :
Cubic Capacity
Cm3
I undersigned:
CAR LENDING AUTHORIZATION
Authorize M.
to drive my car which number plate is :
Date :
Place :
(Signature)
Avis du Contrôle Technique :
www.rallyedumaroc-historique.com
Race N°
Custom Form
CREW
Driver
Race N°
Codriver
First Name Surname
First Name Surname
Date of Birth
Date of Birth
nationality
nationality
passport N°:
passport N°:
City of entrance in Morocco:
City of entrance in Morocco:
TOWING VEHICLE
RACING CAR
On trailer
TRAILER
Brand :
Brand :
Brand :
Type :
Type :
Type :
Plate n°:
Plate n°:
Plate n°:
Height:
Height:
Height:
Length:
Length:
If the vehicles are escorted by the servicing crew, please fill in the following table for each
person.
SERVICING
First Name Surname
SERVICING
First Name Surname
SERVICING
First Name Surname
Date of Birth
Date of Birth
Date of Birth
nationality
nationality
nationality
passport N°:
passport N°:
passport N°:
City of entrance in Morocco:
City of entrance in Morocco:
City of entrance in
Morocco:
Details of the persons and vehicles travelling by boat:
City of entrance in Morocco :
date :
Coming from:
City of exit Morocco :
date :
Going to :