43rd Rally of Lebanon

Entry Form

ENTRANT

Team name*

Nationality*

Competition Licence No.*

Issued By*

Phone (Business)

Phone (Private)

Fax

Mobile*

Address

Email*

1- Driver

First Name*

Surname*

Date Of Birth*

Nationality*

Driving Licence No.*

Issued By*

Competition Licence No.*

Issued By*

Address

Passport No.*

Email*

Phone (Business)

Phone (Private)

Fax

Mobile*

2- Co-Driver

First Name*

Surname*

Date Of Birth*

Nationality*

Driving Licence No.*

Issued By*

Competition Licence No.*

Issued By*

Address

Passport No.*

Email*

Phone (Business)

Phone (Private)

Fax

Mobile*

DETAILS OF VEHICLE

Make*

Model*

Year Of Manufacturing*

Group & Class*

Cubic Capacity*

Chassis No.*

Engine No.

Predominant Color*

Registration No.*

Country Of Registration*

FIA Homologation No.*

Technical Passport No.*

ENTRY FEES *

Type of Entry	With optional advertising	Without optional advertising	Closing date
Private (Aboard the vehicle)	1600.- U.S. Dollars ($)	3200.- U.S. Dollars ($)	Thursday, August 19th @17:00, 2021
Legal Entity	3200.- U.S. Dollars ($)	6400.- U.S. Dollars ($)	Thursday, August 19th @17:00, 2021

PAYMENT MODE *

Payment Mode

Document No.

ASN Authorization*

Payment Proof Attachment*

- For the Entry to be valid, the payment proof should be attached in the payment mode section.
- The Entry approval will be final upon receiving the transferred amount in our blank account.(In case of bank transfer)

DECLARATION INDEMNITY

I/We the undersigned hereby declare that I/we take part in the 43rd Rally of Lebanon at my/our own risk. I/We will not hold the Organiser, its Officials, The Automobile and Touring Club of Lebanon or the FIA responsible for any accidents, injuries etc. occurring during the rally. I/We have knowledge of and undertake to follow regulations and rules governing the event, as well as instructions and decisions of the Stewards of the Meeting

I agree

ACKNOWLEDGEMENT AND AGREEMENT

I/We the undersigned hereby declare that all the information contained on this form and to the best of my/our knowledge and belief are true and correct in every particular. Nevertheless, I/we acknowledge that I/we have read the above declaration of indemnity and I/we accept all the terms and conditions relating to the participation in the 43rd Rally of Lebanon and agree to be bound in full by them.

I agree