Season Entry Form 2019

BLANCPAIN GT WORLD CHALLENGE ASIA SEASON ENTRY FORM 2019 Please fill the form below (one per car) and return it signed with a proof of payment and copies of the Team and Drivers Licences (Front and Back) to : BENJAMIN FRANASSOVICI - Blancpain GT World Challenge Asia Manager / By Email : [email protected] Sepang Intl. Circuit Chang Intl. Circuit Suzuka Intl. Circuit FULL SEASON ROUND Fuji Speedway Yeongam Intl. Circuit Shanghai Intl. Circuit COMPETITOR / TEAM TEAM NAME NATIONALITY TEAM MANAGER NAME ADDRESS POSTCODE CITY COUNTRY TELEPHONE MOBILE EMAIL ENTRANT LICENCE N°/ issued by/AS N (country of issue) ENTRANT LICENCE GRADE ENTRANT LICENCE NAME CAR / MODEL CAR / YEAR OF SPEC TRANSPONDER NO ° PREFERRED RACE NUMBER GIVEN RACE NUMBER (TO BE FILLED BY SRO) (GIVE 3 NUMBERS) / / SELECT BELOW THE SERIES AND CATEGORY YOU WISH TO ENTER CATEGORY GT3 ENTRY FEES PRO-AM AM CUP GT3 GTC Before 31/12/2018 SILVER CUP $ 42,000 $ 36,000 *Early Bird CATEGORY GTC After 31/12/2018 $ 45,000 $ 38,000 PRO-AM AM CUP After 31/01/2019 $ 48,000 $ 40,000 Race By Race $ 8,500 $ 7,000 *Subject to Capacity DRIVER 1 DRIVER 2 FULL NAME FULL NAME NATIONALITY NATIONALITY DATE OF BIRTH AGE* DATE OF BIRTH AGE* LICENCE NUMBER LICENCE NUMBER GRADE GRADE ASN INT C is ASN INT C is mandatory mandatory DRIVER FIA GRADING DRIVER FIA GRADING FIA GRADING IS REQUIRED FIA GRADING IS REQUIRED ADDRESS ADDRESS MOBILE MOBILE EMAIL EMAIL EMERGENCY EMERGENCY TEL NUMBER/NAME TEL NUMBER/NAME *IF DRIVER IS UNDER 18 A PARENT OR GUARDIAN MUST COUNTERSIGN PAGE 2 *IF DRIVER IS UNDER 18 A PARENT OR GUARDIAN MUST COUNTERSIGN PAGE 2 SRO MOTORSPORTS ASIA Units 605-08, 6/F, Wing On Centre, 111 Connaught Road Central, Sheung Wan, Hong Kong BLANCPAIN GT WORLD CHALLENGE ASIA SEASON ENTRY FORM 2019 2019 CALENDAR MALAYSIA | 06 - 07 APRIL 2019 Sepang International Circuit THAILAND | 11 - 12 MAY 2019 Chang International Circuit JAPAN | 22 - 23 JUNE 2019 Suzuka International Circuit JAPAN | 06 - 07 JULY 2019 Fuji Speedway International Circuit KOREA | 03 - 04 AUGUST 2019 Yeongam International Circuit CHINA | 27 - 28 SEPTEMBER 2019 Shanghai International Circuit DECLARATION I declare that I have been given the opportunity to read the General Regulations of the AAM and, if any, the Supplementary Regulations and commercial undertakings for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept this risk. Further I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence. I also understand that the Series Promoters enter into a number of contracts each year in connection with the staging of the Series, including (without limitation) with the owners and operators of circuits which host Series events (collectively, and together with any ancillary or related terms, conditions, rules and/or regulations, the “Contracts”). Therefore, as a fundamental condition of the Series Promoters permitting you to participate in the Championship, you hereby agree to indemnify the Series Promoters against all liabilities, costs, expenses, damages and losses (including but not limited to any direct, indirect or consequential losses, loss of profit, loss of reputation and all interest, penalties and legal costs and all other professional costs and expenses) suffered or incurred by the Series Promoters (or any of its directors, officers, employees, agents or advisers) arising out of or in connection with: (i) any actual or alleged breach by the Series Promoters of any Contract where such breach or alleged breach is caused by the actions or omissions of you or (in the case of each team) any of your officers, employees, agents and/or advisers (including, without limitation, all drivers, pit staff, support personnel and any other individual gaining their accreditation to attend Championship events through or from you or any such person); and/or (ii) any breach by you or (in the case of each team) any of your officers, employees, agents and/or advisers (including, without limitation, all drivers, pit staff, support personnel and any other individual gaining their accreditation to attend Championship events through or from you or any such person) of The Blancpain GT World Challenge Asia Regulations 2019. To the best of my belief the drivers possess the standard of competence necessary for an event of the type the entry relates to and that the vehicle entered is suitable and roadworthy for the event having regard to the course and the speeds which will be reached. The use of the vehicle hereby entered is covered by insurance as required by the law which is valid for such part of this event as shall take place on roads as defined by law. I understand that should I at the time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I have declared such a disability to the ASN which have, following such declaration, issued a licence which permits me to do so. Any application form for a licence which was signed by a person under the age of 18 years was countersigned by that person’s Parent/Guardian/Guarantor, whose full name and addresses have been given. If I am the parent/guardian/guarantor of the driver I understand that I have the right to be present during any procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of the AAM. I also understand that this entry form is provisional until the vehicle details have been submitted and accepted. Once the details have been checked the entrant will be informed. This entry refers to the team and car specified and cannot be re-assigned. In exceptional circumstances teams may be able to move this registration to another vehicle but only with the express, written permission of the organisers of the championship. Any prize money will be made payable to the team unless otherwise requested in writing and signed by both the team and drivers. The full registration fee as laid down in the regulations (1.4.2) is payable to SRO and must be included with this registration. This fee is non-returnable. Entrants may, if they wish, enter on a race-by-race basis at the cost detailed in the championship regulations and is payable to SRO. The fee for the first round must be included with this registration fee and subsequent payments must be received by the co-ordinator at least one full week prior to each event. You are advised that information on this form will be stored on a data retrieval system and may be used for publicity purposes. I agree to rounds of the championship being substituted in the event of a cancellation. I agree to abide by the published 2019 Blancpain GT World Challenge Asia Regulations including Team Commercial Agreement and to repay any costs incurred by negligence and non-adherence to these Regulations and Undertakings. SRO ACCOUNT DETAILS BILLING ADDRESS (IF DIFFERENT TO TEAM NAME) SRO MOTORSPORTS ASIA LTD USD NAME THE ROYAL BANK OF SCOTLAND PLC, SOUTH KENSINGTON BRANCH VAT N° 29 OLD BROMPTON ROAD ADDRESS LONDON SW7 3JE – UNITED KINGDOM SWIFT Code – RBOSGB2L IBAN – GB79 RBOS 1663 0000 7781 88 SIGNATURES I THE UNDERSIGNED AGREE BY THE RULES AND REGULATIONS LAID DOWN IN THE 2019 BLANCPAIN GT WORLD CHALLENGE ASIA REGULATIONS DRIVER 1 DATE DRIVER 2 DATE PARENT/GUARDIAN ENTRANT DATE DATE (DRIVER A/B) “I the undersigned declare that the above is exact DATE and I agree to respect the Sporting & Technical regulations and the Commercial Agreement of the 2019 Blancpain GT World Challenge Asia, as well as information notes, decisions from SIGNATURE the SRO Bureau”. Please note that it is strictly forbidden to display any other watch manufacturers on cars/ overalls/team equipment than the one of the Series Partner, Blancpain. Entries will only be accepted accompanied by the payment, and are subject to available space. No refunds will be made on entry fees. Entry fees may not be transferred to another team. SRO MOTORSPORTS ASIA Units 605-08, 6/F, Wing On Centre, 111 Connaught Road Central, Sheung Wan, Hong Kong.

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