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2W RALLY OF MAHARASHTRA
30-31 MAY 2015
(1st
Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015)
ENTRY FORM
ENTRY FORM ENTRANT (If other than Rider) RIDER
Team Name      
Surname            
First (given) name            
Place            
Blood Group      
Date of birth      
Communication Address
Telephone (business)            
Telephone (private)            
Mobile            
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Page 1
2W RALLY OF MAHARASHTRA
30-31 MAY 2015
(1st
Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015)
Fax No.            
Email address            
FMSCI Comp. Lic. No.            
PAN            
FMSCI xxx Reg.No. NA NA
Driving License No.      
PA Policy Details
Policy
No.
Amount Issued by
Rider                  
                 
DETAILS OF THE VEHICLE
Make       Registration No.      
Model       CC      
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Page 2
2W RALLY OF MAHARASHTRA
30-31 MAY 2015
(1st
Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015)
Year of
Manufacture
      Chassis No.      
Class Entered       Engine No.      
Homologation
No.
     
Predominant
Color
     
Special Rally Cover Insurance
NUMBER COMPANY VALID FROM VALID TILL
Name of
Tuner
     
For official use;
Standard Entry Fees
Sl. Class
Entry Fee
(with Optional Advtg)
Entry Fee
(without Optional Advtg)
1
2
3
Team Entrant Manufacturer Rs.20,000/= per Motorcycle
(Additional upto 4 Motorcycles)
Late Entry Fees Rs.5000/=
For this Entry Form to be valid it must be accompanied by the appropriate Entry Fees, a receipt for the full
amount paid to the Organisers, a bankers draft in the Name of “pitstop” payable at Nashik or details of a
bank transfer, etc.
Seeding Information
FIM Seed, Mention Year :
     
FIM Priority A FIM Priority B FMSCI A Seed FMSCI B Seed
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Page 3
2W RALLY OF MAHARASHTRA
30-31 MAY 2015
(1st
Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015)
Please give below the number of rallies and overall placing you have entered since last 3 years so that we
can give you club seeding and also if you are a First Timer please specify so.
Indemnity & Declaration
I/We hereby make an application to participate in the above mentioned rally and certify that the
particulars of my vehicle as given overleaf are correct, that I/We have read the Supplementary Regulations
issued by Organisers for the said rally and agree to be bound by any of the International Sporting Code of
the FIM, the General Prescriptions for 2W, Sporting Regulations and Championship Regulations of FMSCI; as
well as the undertaking on this entry form.
I have read the Regulations issued for this event and agree to be bound by them. In consideration of the
acceptance of this entry, I agree to save harmless and keep indemnified the Government, the FMSCI, the
Organisers, the FIM and their officials, the Sponsors, agents, representatives, employees and all persons
assisting them in this event and all owners and tenants of private property traversed by this event, from and
against all actions, claims, cost, 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 Motorcycle concerned in this event and
test, if any or otherwise howsoever and not withstanding that the same may have been contributed or
occasioned by the negligence of the Organizer and their official, agents, representatives, employees and
all persons assisting them in this event. The indemnity shall be binding on my heirs, executors and legal
representatives. I/we declare that I/we shall not post any wrong and or provoking information/comment on
social media of any kind neither to any media personnel. All grievances / problems will be addressed
through correct procedures as laid down in the sporting code, general prescriptions applicable to the
respective event and supplementary regulations of the event.
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Page 4
2W RALLY OF MAHARASHTRA
30-31 MAY 2015
(1st
Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015)
I/We also undertake to compensate and or settle all third party damages of any kind, caused by me/us, my
representative/s or who so ever connected with me/us during the event.
I declare that the Riders posses the standard competence necessary for an event of this type to which this
entry relates, also that the vehicle entered is suitable and rally-worthy for the event. I agree and undertake
to abide by the rules and regulations framed for this event including the conditions precedent set out herein
and all other rules and regulations, which may hereinafter be framed.
Finally I/We hereby acknowledge that I / We am / are fully conversant with the risk and dangers of Motor
Sports in general and this rally in particular which I/WE assume hereby.
PLACE & DATE
Signature of the Entrant Signature of the Rider
Name and address of the witness:     
Media Information Kit Rider
Name            
Place            
Date of birth            
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Page 5
2W RALLY OF MAHARASHTRA
30-31 MAY 2015
(1st
Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015)
Team            
Championship Titles            
INRC Debut            
INRC wins
           
Website            
Motorcycle RIDER Highlights
2014            
2013            
2012            
2011            
Motorcycle Rider
Summary
           
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Page 6
2W RALLY OF MAHARASHTRA
30-31 MAY 2015
(1st
Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015)
Favorite Motorsport
Icon
           
Hobby            
Signature            
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Entry form mrf 2 w rally of maharashtra

  • 1. 2W RALLY OF MAHARASHTRA 30-31 MAY 2015 (1st Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015) ENTRY FORM ENTRY FORM ENTRANT (If other than Rider) RIDER Team Name       Surname             First (given) name             Place             Blood Group       Date of birth       Communication Address Telephone (business)             Telephone (private)             Mobile             Powered By Organized by Under the aegis of Page 1
  • 2. 2W RALLY OF MAHARASHTRA 30-31 MAY 2015 (1st Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015) Fax No.             Email address             FMSCI Comp. Lic. No.             PAN             FMSCI xxx Reg.No. NA NA Driving License No.       PA Policy Details Policy No. Amount Issued by Rider                                     DETAILS OF THE VEHICLE Make       Registration No.       Model       CC       Powered By Organized by Under the aegis of Page 2
  • 3. 2W RALLY OF MAHARASHTRA 30-31 MAY 2015 (1st Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015) Year of Manufacture       Chassis No.       Class Entered       Engine No.       Homologation No.       Predominant Color       Special Rally Cover Insurance NUMBER COMPANY VALID FROM VALID TILL Name of Tuner       For official use; Standard Entry Fees Sl. Class Entry Fee (with Optional Advtg) Entry Fee (without Optional Advtg) 1 2 3 Team Entrant Manufacturer Rs.20,000/= per Motorcycle (Additional upto 4 Motorcycles) Late Entry Fees Rs.5000/= For this Entry Form to be valid it must be accompanied by the appropriate Entry Fees, a receipt for the full amount paid to the Organisers, a bankers draft in the Name of “pitstop” payable at Nashik or details of a bank transfer, etc. Seeding Information FIM Seed, Mention Year :       FIM Priority A FIM Priority B FMSCI A Seed FMSCI B Seed Powered By Organized by Under the aegis of Page 3
  • 4. 2W RALLY OF MAHARASHTRA 30-31 MAY 2015 (1st Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015) Please give below the number of rallies and overall placing you have entered since last 3 years so that we can give you club seeding and also if you are a First Timer please specify so. Indemnity & Declaration I/We hereby make an application to participate in the above mentioned rally and certify that the particulars of my vehicle as given overleaf are correct, that I/We have read the Supplementary Regulations issued by Organisers for the said rally and agree to be bound by any of the International Sporting Code of the FIM, the General Prescriptions for 2W, Sporting Regulations and Championship Regulations of FMSCI; as well as the undertaking on this entry form. I have read the Regulations issued for this event and agree to be bound by them. In consideration of the acceptance of this entry, I agree to save harmless and keep indemnified the Government, the FMSCI, the Organisers, the FIM and their officials, the Sponsors, agents, representatives, employees and all persons assisting them in this event and all owners and tenants of private property traversed by this event, from and against all actions, claims, cost, 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 Motorcycle concerned in this event and test, if any or otherwise howsoever and not withstanding that the same may have been contributed or occasioned by the negligence of the Organizer and their official, agents, representatives, employees and all persons assisting them in this event. The indemnity shall be binding on my heirs, executors and legal representatives. I/we declare that I/we shall not post any wrong and or provoking information/comment on social media of any kind neither to any media personnel. All grievances / problems will be addressed through correct procedures as laid down in the sporting code, general prescriptions applicable to the respective event and supplementary regulations of the event. Powered By Organized by Under the aegis of Page 4
  • 5. 2W RALLY OF MAHARASHTRA 30-31 MAY 2015 (1st Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015) I/We also undertake to compensate and or settle all third party damages of any kind, caused by me/us, my representative/s or who so ever connected with me/us during the event. I declare that the Riders posses the standard competence necessary for an event of this type to which this entry relates, also that the vehicle entered is suitable and rally-worthy for the event. I agree and undertake to abide by the rules and regulations framed for this event including the conditions precedent set out herein and all other rules and regulations, which may hereinafter be framed. Finally I/We hereby acknowledge that I / We am / are fully conversant with the risk and dangers of Motor Sports in general and this rally in particular which I/WE assume hereby. PLACE & DATE Signature of the Entrant Signature of the Rider Name and address of the witness:      Media Information Kit Rider Name             Place             Date of birth             Powered By Organized by Under the aegis of Page 5
  • 6. 2W RALLY OF MAHARASHTRA 30-31 MAY 2015 (1st Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015) Team             Championship Titles             INRC Debut             INRC wins             Website             Motorcycle RIDER Highlights 2014             2013             2012             2011             Motorcycle Rider Summary             Powered By Organized by Under the aegis of Page 6
  • 7. 2W RALLY OF MAHARASHTRA 30-31 MAY 2015 (1st Round of MRF MOGRIP FMSCI National Rally Championship-2W, 2015) Favorite Motorsport Icon             Hobby             Signature             Powered By Organized by Under the aegis of Page 7