MINISTRY OF THE YOUTH AND SPORTS Emmanuel Anquetil Building, 3 rd Floor, Port Louis

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1 1 MINISTRY OF THE YOUTH AND SPORTS Emmanuel Anquetil Building, 3 rd Floor, Port Louis Application Form for recognition as a Sports Club Section 1 - Organization s details & administrative back-up 1.1 Name of Applicant Sports Club 1.2 Contact Name / Position Full Postal Address of Sports Club Telephone number Fax 1.3Legal constitution of Sports Club (Tick where appropriate) Is the Sports Club already registered with the Registrar of Association? Yes No If yes, state the registration number: Date of registration:... Is the Sports Club affiliated to any National Sports Federation? Yes No *If yes please state which National Sports Federation and the date of affiliation: *If not yet affiliated to any National Sports Federation, state from which National Sports Federation your sports club intends to obtain affiliation

2 2 Section 2 - About Current Membership, Technical & financial back-up 2.1 How many licensees and do you have? Please complete the following table. Category Man Woman Total Under 15 years Under 20 years Over 20 years TOTAL State the annual membership fee claimed from each member Rs. 2.2 How many coaches/technical cadres do you have? List down the names of the coaches / technical cadres and their qualifications. Names of coaches / technical cadres Qualifications 2.3 Do you have a defined calendar of activities for the sports Club? Yes No

3 3 2.4 Please provide details of your current sports programme/coaching activities. Category No. of Duration of Total No. Of sessions Please include further details sessions sessions e.g 1 per year about your coaching per week hour programme e.g. names of Under 15 years Boys coaches for each category, Under 15 years Girls Under 20 years Boys venue, days, time of training, etc as required and stated at Appendix 11 of section 3 of this Under 20 years Girls application Over 20 years Man Over 20 years Woman 2.5 List down the different sources of income of your Sports Club during the previous financial year. Source Income (Rs.) Total 2.6 List down the different expenses incurred by your Sports Club during the previous financial year. Item Expenses incurred (Rs.) Total

4 4 Section 3 - Documentary Requirements S.No. DOCUMENTS TO BE SUBMITTED TOGETHER WITH THIS TICK IF TO BE MARKED APPLICATION ENCLOSED AS 1. Copy of certificate of incorporation of your Sports Appendix 1 Club, if any 2. Copy of the Constitution/Rules/ Memorandum/Bye laws Appendix 2 and Articles of your Sports Club, if any 3. Composition of Managing committee of your Sports Appendix 3 Club with details of phone numbers and addresses of all members 4. Copy of your affiliation confirmation with the Appendix 4 appropriate National Sports Federation, if any 5. Income & expenditure statement for the previous year Appendix 5 6. Copy of qualifications of each coach listed at paragraph Appendix Calendar of activities of your sports club for the Appendix 7 previous year 8. Calendar of activities of your sports club for the current Appendix 8 year 9. List and names of all members/athletes of your club per category (Refer to Paragraph 2.2) with details of the license number, home address and phone number as well as the performances in official competitions organized by the appropriate National Sports Federation for each of them Appendix List of high level athletes of your sports club & their major Appendix 10 achievements 11. List and names of training structures of your sports club with Appendix 11 details of names of coaches in charge for each structure, venue, days & time of training If not submitted, please state reason

5 5 I, the undersigned, on behalf of the applicant sports club understand and agree that: (i) I am authorised to complete this application on behalf of the applicant sports club. (ii) Providing false information constitutes an offence under the Sports Act (iii) All information submitted in this application and in the supporting documentation is truthful and accurate and the Ministry of Youth and Sports will be informed if there are any changes to this application or any change in circumstances affecting the application. Signature: Name in BLOCK LETTERS: POSITION: Date:

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