ROAD TO LE MANS CIRCUIT DES 24 HEURES 15/18 JUNE 2016

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1 ROAD TO LE MANS CIRCUIT DES 24 HEURES 15/18 JUNE 2016 ENTRY FORM Registration Opening : 18th March 2016 Closing date : Friday 15th April (midnight) ENTRANT Entrant name Licence Nationality The maximum number of characters is 25, with spaces counting as characters Competitor s licence N TEAM PRINCIPAL Surname / Family Name First Name Phone Mobile

2 TEAM MANAGER (IF DIFFERENT CONTACT) Surname / Family Name First name Phone Mobile CAR INFORMATION Category LMP 3 GT3 Manufacturer CAR Name, make, model & type (cf. Homologation form) FIA Homogolation number for the GT3 car Chassis denomination Chassis number

3 Make of the tyres Multifrequency Radio N Type of fuel used ENGINE Engine Engine Type Normally Aspirated Surcharged Turbo charged Total cylinder capacity (cm3) Number of cylinders Number of valves per cylinder Type of fuel used Number of restrictor(s) CAR NUMBER REQUESTED The Selection Committee cannot guarantee that you will receive the requested number DRIVER #1 Surname/Family Name First name Nationality (Passport) Date of birth

4 Place of birth Mobile Website Facebook Twitter STATUS FIA International Licence number Licence grade Delivered by (ASN name) Driver s Categorisation Silver Bronze DRIVER #2 Surname/Family Name First name

5 Nationality (Passport) Date of birth Place of birth Mobile Website Facebook Twitter STATUS FIA International Licence number Licence grade Delivered by (ASN name) Driver s Categorisation Silver Bronze

6 BILLING ADDRESS INFORMATION The entry fees will be charged for and overpayment received on the deposit for technical expenses and suppliers will be refund by bank transfer on the same account from which the payment ACO received was made. Company Intra Communaty VAT Number Surname / Family Name First name Phone BANK INFORMATION OF THE BENEFICIARY Beneficiary name Bank

7 Bank Account Number IBAN SWIFT / BIC ABA FINANCIAL CONDITIONS (entry fee and advance on supplies and other technical costs) Amount (s) to be settled : Case 1 Company registered to VAT or registered as a business company in a country outside the European Union. A business registration issued by the department of treasury of your state (US Competitor) or your country is mandatory. Should this certificate of registration not be attached with your entry form, French taxes (VAT) will be due by your company (20 % in addition to the entry fees) Case 2 Company registered to VAT in another European country (ECC) than France Case 3 Competitor not liable to VAT or not liable to corporate taxes (business activities) (Total excluding VAT + VAT 20 %) Case 4 Company registered in France regarding VAT (Total excluding VAT + VAT 20 %) Beneficiary Bank details Bank transfer only Please specify the team s name in the bank tranfers details CREDIT MUTUEL Account owner : SA SSP ACO Account: Bank Code: Branch Code: Account N : IBAN: FR BIC: CMCIFR2A

8 COMPETITORS DECLARATIONS The ROAD LE MANS event is organised according to : 1/ the provisions of the FIA International Sporting Code and its appendices, 2/ the Sporting Regulations of the Michelin GT3 Le Mans Series 3/ the ACO LMP3 and FIA GT3 Technical Regulations. 3/ the Specific Regulations of the Road to Le Mans event. We confirm that we have read and understood the provisions of the FIA International Sporting Code and its appendices, the Sporting Regulations of the Michelin GT3 Le Mans Series, the ACO LMP3 and FIA GT3 Technical Regulations and the Specific Regulations of the Road to Le Mans. We agree, on our own behalf and behalf of everyone associated with our participation in this event to observe and be bound by them (as supplemented or amended). We understand that only entries made no later than the closing dates and times set by the organiser may be reviewed and then taken into consideration for the selection of competitors. We understand that, in order to be valid, the entry must be completed and with all required documents (see Specific Regulations Art. 3 / Entries). We agree to attach all documents mentioned below (point 3 of this entry form). We declare that we have ensured that the information registered on this entry form is true, correct and complete. The organiser is not responsible for false and incorrect information. SPECIFIC DECLARATIONS For commercial and financial aspects regarding the participation of teams and manufacturers in this event, please contact the organiser at the following address : Circuit des 24 Heures LE MANS (France) Tel : The competitor recognizes that this entry is conditional upon acceptance by the Selection Committee and that no official declaration regarding their participation in this event can be made before the publication of the official entry list of competitors admitted to take part in the Road Le Mans event. We the competitor also undertake, on behalf our drivers, to abide by the rules forbidding doping and to accept any chekcks to be untertaken by the mandated doctors. 1 Entry We the competitor recognize that this entry form will be valid only if the payment of the sums required by the organiser (see the Road Le Mans Specific Regulations) is made before the official closing date for entries, and is subject to the acceptance of the entry by the Road to Le Mans event. Decisions taken by the Selection Committee cannot be appealed. 2 VAT System We the competitor recognize that the amounts stipulated in the Specific Regulations are exclusive of taxes, and that the payment of the entry fees must be made either inclusive or exclusive of taxes by each competitor, depending on the fiscal rules applications

9 3 Must be attached with the entry form: FIA 2016 International Competitor's Licence (the wording of the handed in licence will be deemed) Detailed explanations likely to enlighten the choice of the Selection Committee; Photograph showing colour of the car ¾ AV ¾ AR, inside cockpit Copy of the passport of each drivers Confirmation by the team that it has informed all its drivers of the obligation to use an FIA approved head restraint system and to have a helmet compatible with the transponder used (plug for connecting to the transponder). Under no circumstances may a helmet be modified after delivery by the manufacturer FIA 2016 International Drivers licence Full name and record of achievements of each of the drivers (maximum 2 per car); Copy of the bank transfer of the fees A proof of registration as a VAT taxable person for the competitors concerned: 1. Company registred to VAT in France. 2. Company registred to VAT in another European country than France 3. A business registration issued by the department of treasury of your state (US Competitor) or your country for the Companies registered to VAT or registered as a business company in a country outside the European Union At, on Signature of the entrant Signatory s name and surname Entry file to be sent to : ROAD TO LE MANS For attention of Isabelle RAVENEAU Circuit des 24 Heures du Mans CS F LE MANS Cedex 2

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