QATAR CROSS COUNTRY - AUTO Entry Form

ENTRY FORM - AUTO

ENTRANT*

Entrant Name

Competition Licence

Issuing ASN

E-maila valid email

AddressThis is the mailing address

P.O.Box

Country

Phone(Business)

Mobile

Fax

Tel No (Qatar)

Please enter the phone and fax numbers in international format (e.g +000 xxxx xxxx)

DRIVER*

First Name

Family Name

Date Of Birth

Passport No.

Issued Date

Expiry Date

Competition Licence No.

Issuing ASN

Driving Licence No

E-maila valid email

AddressThis is the mailing address

P.O. Box

Phone No (Private)

Fax

Mobile No

Next In Kin

Relationship

Telephone No

Please enter the phone and fax numbers in international format (e.g +000 xxxx xxxx)

CO-DRIVER*

First Name

Family Name

Date Of Birth

Passport No.

Issued Date

Expiry Date

Competition Licence No.

Issuing ASN

Driving Licence No.

E-mail

Address

P.O.Box

Phone No (Private)

Fax

Mobile No

Next In Kin

Relationship

Telephone No

Please enter the phone and fax numbers in international format (e.g +000 xxxx xxxx)

2ND CO-DRIVER (Only for T4)*

First Name

Family Name

Date Of Birth

Passport No.

Issued Date

Expiry Date

Competition Licence No.

Driving Licence No.

E-mail

Address

P.O.Box

Phone No (Private)

Fax

Mobile No

Next In Kin

Relationship

Telephone No

DETAILS OF THE VEHICLE *

Owner Name

Make

Model

Color

Engine CC

Registration No.

Chassis No

Engine No

FIA Homologation No

FIA Tech. Passport No

DOCUMENTS UPLOADS *

Entrant’s licenceupload

Upload

Driver competition licensesupload

Upload

Co-driver competition licensesupload

Upload

Driver passports or identificationupload

Upload

Co-driver passports or identificationupload

Upload

ASN authorization for foreign driversupload

Upload

ASN authorization for foreign co-driversupload

Upload

Drivers’ driving licencesupload

Upload

co-Drivers’ driving licencesupload

Upload

VEHICULE DOCUMENTS UPLOADS *

Rally car’s registration papersupload

Upload

Car insurance cover certificateupload

Upload

Car owner authorization to participate in the Rallyupload

Upload

FIA Technical Passportupload

Upload

FIA Homologation Form(T2 and T4 vehicles)upload

Upload

ENTRY FEES *

Type Of Entry

Until 15 March 2018

Until 05 April 2018

Overseas Entries

T1,T2 & T3

$ 6,970

$8,400

Overseas Entries

$ 8,310

$ 9,940

Gulf & Qatar Entries

T1,T2 & T3

QAR 11,100

QAR 12,400

Gulf & Qatar Entries

QAR 14,800

QAR 17,700

Tracking System Rental - €175.00

All entry fees must be paid by bank transfer, to the following bank

account: Qatar Motor & Motorcycle Federation (QMMF)

Bank name: Qatar International Islamic Bank Branch: Main Branch,

Grand Hamad Avenue, P.O.Box 664, Doha, Qatar.

Account Number: 1111-410066-001 Swift Code: QIIBQAQA

Please attach your Payment Proof of the Entry Fee and Tracking system rental fee

Payment Proof Attachment - Entries will be countable as valid entry only if the payment proof is attachedupload

Upload

ACKNOWLEDGEMENT AND AGREEMENT *

I Agree

I, the undersigned take part in the Sealine Cross Country Rally at my own risk. I exonerate the FIA, QMMF, the Organizers and officials, their employees, officers and agents from any and all liability for any loss, damage or injury, which I may incur in the course of the event. Furthermore, I undertake to indemnify and hold harmless the FIA, QMMF, the Organizers and officials, their employees, officers and agents from and against any and all liability to third parties for any loss, damage or injury which I am jointly and severally liable.