http://www.facebook.com/#!/Hyperformance.Motorsport E-Mail: witnesstowonder@yahoo.com, Works: H-220 , SECTOR 63, NOIDA.

PH: 9810128896

AUTOCROSS: RACE OF CHAMPIONS 4 (2012)

(Approved by the Federation of Motor Sports Clubs of India) Entry Form Entrant Name

Address

City Tel (Off) Mobile

Tel (Res) Email

Pin

FMSCI Lic. No. or download from www.fmsci. co.in Blood Group : Allergy : Valid Civil D/L no. :

Vehicle Details

Make Registration No.

Model Engine No.

Year of Manufacture

CC

Chassis No.

Vehicle Details Make Registration No. Model Engine No. Year of Manufacture CC Chassis No.

Vehicle Details Make Registration No. Model Engine No. Year of Manufacture CC Chassis No.

Vehicle Details Make Registration No. Model Engine No. Year of Manufacture CC Chassis No.

FOR MORE DETAILS : http://www.facebook.com/#!/Hyperformance.Motorsport CONTACT FOR ENTRIES NIVIT BHASIN 9810128896

HYPERFORMANCE MOTORSPORTS , ADD: H -220,SECTOR 63, NOIDA.

1)OPENING OF EARLY ENTRIES 7TH FEB 2012 CLOSING OF EARLY ENTRY 15TH FEB 2012 EARLY ENTRY FEE: -INDIAN CATEGORY Rs. 1800/- PER ENTRY (PLS TICK IN FRONT OF ALL CATEGORIES THAT YOU WISH TO PARTICIPATE IN) -IMPORT CATEGORY Rs. 2000/- PER ENTRY (PLS TICK IN FRONT OF ALL CATEGORIES THAT YOU WISH TO PARTICIPATE IN)

2)OPENING OF STANDARD ENTRIES 15TH FEB 2012 CLOSING OF STANDARD ENTRIES 18TH FEB 2012 STANDARD ENTRY FEE: -INDIAN CATEGORY-Rs. 2000/-PER ENTRY (PLS TICK IN FRONT OF ALL CATEGORIES THAT YOU WISH TO PARTICIPATE IN) -IMPORT CATEGORY-Rs. 2200/- PER ENTRY (PLS TICK IN FRONT OF ALL CATEGORIES THAT YOU WISH TO PARTICIPATE IN) PUBLICATION OF EARLY / STANDARD ENTRY LIST 20TH FEB 2012

http://www.facebook.com/#!/Hyperformance.Motorsport FMSCI WEBSITE

ON

3)OPENING OF LATE ENTRIES (subject to availability) 19TH FEB 2012 CLOSING OF LATE ENTRIES 22ND FEB 2012 LATE ENTRY FEE : 19TH 22ND FEB 2012 : RS 2500/- PER ENTRY.

NOVICE CATEGORY:

1.Upto 800cc 2.801cc to1100cc 3.1101cc to 1400cc 4.1401cc to 1600cc 5.1601cc and above 6.SUV 7.ladies category

PROFESSIONAL CATEGORY: 1.Upto 800cc 2.801cc to1100cc 3.1101cc to 1400cc 4.1401cc to 1600cc 5.1601cc and above 6.SUV 7.ladies category
DOCUMENT SUBMISSION -Competitors are required to produce for verification the following in original: 1-Vehicle Registration Book with Tax paid plate. 2-Civil driving license 3-FMSCI Club sport competition license 4-Insurance for the Vehicle 5-Rally Cover Insurance (Not mandatory) 6-Personal accident policy for the event days 7-4 Photographs 8-Authority letter from the owner of the car, if the driver is not the owner of the car.(on Rs 20/stamp paper) 9-Blood group certificate

The competitors are required to carry all the above documents throughout the Event.
All drivers must wear crash helmets, which are ISI approved or meet International Standards. Wearing of 3

point seat belt is mandatory.

Indemnity ( To be filled on Rs 20 stamp paper and attested by notary public)

I/We have read the Regulations issued for this event and agree to be bound by them. In consideration of the acceptance of the entry of this machine, I/We agree to save harmless and keep indemnified the Government of India, the relevant State Government, the FIM, FIA, the FMSCI, the organizers / promoters and their officials, the sponsors, agents,

representatives, employees and all persons assisting them in this event and all owners and tenants and all persons assisting them in this event all actions, claims, costs, expenses and demands in respect of death or injury to myself or any other person or persons or loss or damage to any property including the machine concerned in this event, or otherwise howsoever and notwithstanding that the same may have been contributed to or occasioned by the negligence of the organizers and their officials, agents, representatives, employees and all persons assisting them in this event.

The Indemnity shall be binding on my heirs, executors, administrative and legal representatives. I/We declare that the rider possess the standard of competence necessary for an event of this type to which this entry relates, also that the machine entered is suitable and road worthy for the event. I/We agree and undertake to abide by the Rules and Regulations framed for this event including the conditions precedent set out therein and all Rules and Regulations which may hereinafter be framed. I/We will abide by the decision of lap timing provided by the organizers.

Finally, I/We hereby acknowledge that I/We are conversant with the risks and dangers of motor sport in general and this event in particular which I/We assume hereby.

Date : _____________________

Place : ____________________________

Signature of the Driver : _______________________________

IMPORTANT: Any indemnity and/or declaration as prescribed by the paragraphs above if signed by a person under the age of 18 years, shall be countersigned by that persons parent/guardian, whose full name and address shall be given and also his capacity as signatory.

Signature of Guardian: - _________________Full Name: - ________________________

Address: _____________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Signature of Witness to all the above Signature: - _____________________________________________________________ Full Name & Address of Witness: - ____________________________________________

I hereby confirm that as per Article No 8.2 f I have my accident policy with hospitalization and hence organizers are not responsible.

Sign of the Entrant ___________________Sign of the Driver ________________

FOR OFFICE USE ONLY Received on Amount Receipt No.