ASSOCIATION l IIOLKAR STADIUM, , M.P., Tel: (071I ) 254i602. 2411010 MPCA PLAYERS REGISTRATION FORM Please read instructions carcfully before fill up and submission ofthe fonn at last page

Reg- Fonn No.i Registration No To be filled by MPCA Offr-ce Date of Registfation

D D M M

To, Date: / |

MADHYA PRADESH CR]CKET ASSOCIATION, Paste recent passport STADIUM, LNDORE - 452 OO3 size colour photo of the player here. I WISH TO PARTICIPATE IN THE INTER DIVISIONAL TOURNAMENTS CONDUCTED BY MPCA FOR THE SEASON . KIN DLY ACCEPT MY REGISTRATION FO R THE sAM E AS PER TH E DETAILS MENTIONED UNDER. TOURNAMENT ELIGIBIUW DATE {IFANY) PLEASEV tJ/14 Tournament-A. W. Kanmadikar Trophv Plavers born on orafter - 07.O9.2OO2 U/15 Tournament - M. M.lagdale Trophv Plavers born on or after - 01.09.2000 U/18 (Multi day) Tournament - Hiralal Gaekwad Trophy Players born on or after - 01.09.1997 U/18 (Limited )Tournament - S. M. Khan Trophy Players born on or after - 01.09.1997 U/23 (Multi day) lournament - Parmanadbhai Patel Players born on or after - 01.09.1993 Men's Sr. (multi day) To!rnament - M. Y. Memorial Trophy Men's Sr. (Limited overlTournament - Trophy Men's sr. {T/20)Tournament-J. N. Bhava Trophv Wome'l'5 Tou'nament - l. S. Anand Trophy

DrvrsroN / TEAM DETAILS OF EARLIER REPRESENTATION IN THE SAME AGE GROUP Please V TOURNAMENT (A player may represent his/her division in any single age FIRsTYEAR group for a maximum pe.iod of 4 years. A player who is part of playing ALREADY PI-AYED FOR l YEAR eleven for a team shall be considered to have DarticiDated in the ALREADY PLAYED FOR 2 YEARS tournament that year.) for ALREADY PI"AYED FOR 3 YEARS PERSONAL DETAITS NAME Surname Fi6t name Middle name DATE OF BIRTH DD/MM/YYYY Age Years Months as on today (date) POSTAL ADDRESS Flat/Room No. HOOr Buildins No Building Name society / Mohalla Land mark/ Near by Lane/Road/Street Citv State Prn Contact Player's Residential Landline Mobile No (if any) Contact Parent Residential Landline Mobile No /Guardian's PASSPORT DETAILS DO YOU HAVE PASSPORT YTS / NO IF YtS THEN GIVF DETAI$ BTt LO!. PASSPORT NO ISSUING PLACE DATE OF ISSUE EXPIRY DATE IF APPt!ED FOR PASSPORTAND NOT RECEIVED PASSPORTYET PLEASE GIVE FILE NO AND DATE ASSOCIATION A MADHYA PRADESH CRICKET : HOLKAR STADIUM, INDORE M P' Tel: (07iI ) 2543602, 24i 1 0 10 MPCA PLAYERS REGISTRATION FORM i.:P form at last page Please read instructions carefully bofore fill up and submission ofthe

CONSENT |(p|ayerse|f)/weormeasParentorGrandParentorLegaIGuardianofp|ayerhavereadcarefullyaboveinstructionsand under 5lood, player declare that | {plaYer self) / We or me as | (player self) / We or Me as Parent or Grand Parent dr Legal Guardian of (player our, parent Grand Parent or Legal Guardian have no objection to take my self) / my / and use them for any kind of son/daughter/grandson/granddaughter/niece/nephew/brother/siste/s photograptl /video purpose' publicatLn in riews media / magazine. Also I / we allow using photograph / video for training player declare that our my / our | (playea self) / we or Me as Parent or Grand Parent or Legal Guardian of to represent the MPCA in .oVi"rgf't"igr"nO.on/granddaughter/niece/nephew/brother/sister representing or intending speak, or publish article or act in manner any competition tournament or match snall publically comment, discuss, tal( the forfeiture of my self) which may bring the Association in disrepute. An infr;ngement of this rules will entail {player / right of being selected for any my / our soi/daughter/grandson/granddaughter/niece/nephevbrother/sister's tournament or match, player declare that | (player self) / We or me as I (player self) / We or Me as Parent or Grand Parent or Legal Guardian of of any damages and breakage paient or Grand parent or Legal Guardian undersigned that MpcA shall recover the cost room caused directly or indirectly in the MPCA provided Hotel or dormitories or special | (playersel0TweorMeasParentorGrandParentorLegalGuardlanofplayerdeclarethatl(playerselO lWeormeas parent or Grand parent or LeSal Guardian understood that me (ptayer self) / my/our rules and regulations' son/daughter/grandson/Sranddaughter/nieie/nephew/brother/sister shall be abide by the MPcA player declare that me setf) / my / our t (piayer setq / we or tue as Parent or Grand Parent or Legal Guardian of {player rules and regulation of the son/iar.rghter/grandson/granddaughter/niece/nephevbrother/sister shall not break any MPcA before during and after of tournament and match and coaching camp' Guardian of player declare that me (player selO / my / our | {player self) / we ;r Me as Parent or Grand Parent or Legal explained rules and ,"'nli*cft"|'ig-"aton/Sranddaughter/niece/nephevbrother/sister dectare that we have been regulation of MPCA and selection procedure and seriousness' that submission of a False incorrect DOB document i3 an Me {players self) / we as Parent or legal guardian understood / offence.MPcAoranVcommitteeauthonsedbyHonorarySecretaryshal|takea|egalactionolanyotheradiondeemedfit to MPCA against me (ptayerself)/ parent / legalguardian- risk of the cricket game and give Also we or me as parent or Grand parent o; Le;al Guardian of player understand the consent thar in case ot any in;ident happen to me {player self) | my / our or match or camp MPcA son/daughter/grandson/granddaughter/niece/nephevbrother/siste/s during the tournament shall not be responsible for that. MPCA shall give us support to handle that situation' MPCAhasexplainedtome(p|ayerse|f)/usormeasParentorGrandParentorLegalGuardianofplayeraboveconsent.n EnglishandaswellasjnHindilansuageandme(p|ayerself}lmylou( so;/daughter/grandson/granddaughter/niece/nephew/brother/sister have understood' instructions to my/our son/daughter/grandson/ ,qs a parJnt / tegal Guardian have explained the consent and granddaughter/niece/nephew/brother/sister in locallanguage and they have agreed to follow'

(s) Guardian/ Grand Parent Signature of player Signature of Parent / Legal Place: Name player Datei Relation with Place: Date:

FOR OFFICE USE ONLY Age Verification Test Code No. Bv MPCA Under age in Grou

Secretary Signature of Cricket Operation Manager Signature of Honorary MADHYA PRADESH CRICKET ASSOCIATION : HOLKAR STADIUM,INDORE, M.P., Tel: (0731 ) 2543602,2431010 MPCA PLAYERS REGISTRATION FORM P,93. Please read instructions carefully before filI up and submission ofthe fo]m at last page

INSTRUCTIONS TO FILL UP AND SUBMISSION OF REGISTRATION FORM l his forn] is valid for one year and for specific age group. I-onn to be rubrnined in original. Players / playeis guardians / parents fill up this form in blue ball point pen and in capital lefters only. All points of the Form shall be filled dully and shall be signed by player, player's parentvguardian, Divisional Secretary before submission at MPCA Office. Empty fonn will not be accepted in the MPCA office. Empty fofm or not signed form shali not be accepted and ifany form found not dully filled and signed shall be treatcd as invalid and in such case players / player's guardian / parents / Divisional Secretary / District Secreiary shall not claim registration. MPCA shall notrcsponsible for cancellation ofregistration or not allowing players to play on such condition. MPCA must receive filled and signed registration form 30 days bcfor€ the Toumament starts else rcgistation shall

Write player's full name behind the photogaph. Attach two passport size recent colo!r photos {one photo shatl be pasted in the space provided and one shall be stapled with the form and make sure not stapled on the face). Sign across on the photogmph pasted on the form. Signature shall cover half on form and halfon photo. Signature shall not cover face ofthe player. A playe. may represent hisArer division in any single age $oup for a maximum period of4 years. A player who is a pari ofplaying eleven for a team shall be considered to have participated in the toumament for that year. Read carefully all the points before fitling and submission ofdocuments. A1l proof shall be attached with this form at the time ofsubmission at MPCA. Player shall submit self-attested photocopy ofbirth prcof, rcsidential address proof, identity card, passport, transfer ofdivision since last season. Other documents apart from the listed documents in the form shall not be accepted as proof. Parents (Jointly ) / Individual orjoint Guardian ofevery player shall submit declaration / indemnity from parents / legal guardian of player nominated for age vedfication test in original along with the registmtion form on { 1oo/ non JudicialStamp paper to be attested by Notary Public / Executive / I ud icia I M agistrate {Refer attached copy of declaration to be submitted in Non-ludicialStamp Paper).

s/o, Dlo, FlO, MlO, Guardlan ot

l/ We declare thatgiven information/ documents are genuine and also declare that if MPCA finds that attached document and given information is not genuine in such case MPcA has rightstotake legalaction and discontinue my/ourson/daughter/grandson/granddaughter reelstration and take action deem fitto MPCA.

Signature of player Signature of Parent (s)/ LegalGuardian / Grand Parent Place: Name Date: Relation with player Place: Date: A MADHYA PRADESH CRICKET ASSOCIATION

HOLK,{.R STADIUNI, lN DORE. M.P., Teli (073I ) 2543602,241l0 L0 MPCA PLAYERS REGISTRATION FORM W Please read instructions cafelully before fill up and submission ofthe form at last page

REPRESENTATION DURING LAST SEASON (I.E. {MENTION THE NAME OF TOURNAM BCCITOURNAMENTS MPCA TOURNAMENTS ONLY IF SELECTED IN THE FINAL SQUAD OF 15/1 FOR ANY ONLY IF SELECTED IN THE FINAL SQUAD OF 15/16 FOR ANY MATCH MATCH

AGE VERIFICATION TEST CATEGORY ACTION PLEASE tl PLAYING FOR THE FIRST TIME IN ANY A6E GROUP PLAYER IS RQUIRED TO ATTEND THE CENTRALISED LNTER DIVISIONAL TOURNAMENT MEDICAL TEST AS PER MPCA DIRECTIVES, PARTiCIPATED IN THE INTER DIVISIONAL MENTION THE TOURNAMENT HERE TOURNAMENT FROM SEASON OR AFTER PARTICIPATED IN THE BCCI TOURNAMENT FROM MENTTON THE TOURNAMENT HERE SEASON OF AFTER

PLAYING PROFTCIENCY (PLEASE V WHEREVER APPROPRTATE) RIGHT HAND RIGHT ARM MEDIUM PACE LEFT HAND LEFTARM MEDIUM PACE KEEPER BATSMAN OPENING LEFTARM SPIN MIDDLE ORDER RIGHT ARM OFF SPIN LOWER ORDER RIGHTARM LEG SPIN ANY ONE DOCUMENTS OF EACH SECTION ATTACHED MANDATORITY DOCUMENT ACIION PLEASEV PASSPORT FIRST & LAST PAGE OFTHE PASSPORT TFTHE PLAYERS HASAPPLIED FORTHE PASSPORT BUT THE SAME IS NOT ISSUED, THE PLAYER SHOULD ATTACH PASSPORTAPPLICATION FORM, DATE OF BIRTH a) PASSPORT PRQOF b) 9tRTH CERTTFICATE z C) SCHOOL CERTIFICATE COUNTERSIGNED BY THE 9 SCHOOL ON ANY DATE AFTER z RESIDENCE a) PASSPORT PROOF b) ADHAR CARD C) PARENTS/GUARDIAN'S VOTER ID g d) PARENT,S/GUARDIAN'S ELECIRICITY BILT E) PARENIS/GUARDIAN'S BSNLTELEPHONE BILL. F f) TAHSILDAR'S NIWAS PRAMAN PATRA, z g) PROP€RTY DOCUMENT5 E.G; PATT4 REGISTERED z .. OEED ETC. IN CASE OF A) NOC FROM THE HON,SECRETARY OF THE DIVISION TRANSFER Of HE/SHE PLAYED DURING LASTSEASON, >zt Dtvt5toN SlNcE b) APPLICATION TO THE HON.sECRETARY, MPCA, z6Aa(,k LAsT SEASON REQUE5]ING FOR TRANSFER OF DIVISIOII. >;d PARENT'S/ SIGNING PARENT/ LEGAL GUAROIAN'S ID WITH TEGAL SIGNATURE CARD ISSUED BY GOVERNMENT {PAN CARD, GUARDIAN'5ID PASSPORT, SERVICE ID CARD) slo, Dlo, F/o, Mlo l/ We declare that given information / documents are genuine and also declare that if MPCA finds that attached document and given information is not genuine in such case MPCA has rights to take legal action and discontinue my / our son / daughter / grandson / granddaughter registration and take action deem fit to tulPCA. cidnar"ra ^f Dl'vo.

TNDEMNTTY FRoM paREilrs / LEGAL GUARDTaN oF playERs ;i?trilt?i rHE NoMTNATED FoR s*,rErar

- (furl.t t,,ane- --- or rre Fa.her & r\."*-, L"n"r c"".1"" ii" l.iirj ";

Res. Address : ...... ,..

Madhya Pradesh C.icket Association

1 .ur chird (name of the prayer) rs nominared by the .,....._,,,...... Division crtckei associatjon to. the sketetat r.aturtty test to rzcilitate him participate In rhe rnte. Drvisronat Tournamenrs / other m.tches conducted by rhe MpcA / Divisionat c"q / Bccr,

2. we, the parents tegat qlJa.dian / of the above praver do herebv iolntlv submlt ou' uncondltional pradesh consent to Madhva cricket Associaton oivrsional / ca for the medrcar tesr b be adrninister€d on our chitd as per the requi.ement.

3, we are aware that the chtd wourd be required ro undergo requifed tesrs at the Hosprtals recomhended bv MpcA from

we are aware and agree that the original date of I payer the reports ror the resr. A duy anest". ff:J:T:J;.:il:: Hi:i:ffi;ff::J:; alongwJth 2 re@ht passpon size photographs ofthe ptayer,.

5. We a.e aware and agree that this p.ocedure is €ssentiat |o estlbtistr ttre sreretat maturity parametec of our chitd as per rhe associated with hedtcattests performed to be from time to tim€, :.d.!r.e dr.t qelLrfE

ur b€ . Dart of rh!

rea. i.le.ti.n or.s pres.r bed by ftpCA

w., hereby aqree to unconditon: y acceDt th. rep.rt or the sketet.t maturity.s per the re.ommenoaton co,cernedautho'rva'drndemnifvNrpca/Divrsronarcr'r4rA*qato;i or the concerned hosprra / docrors er., f.rpca oifi.e bearers hanaqemenr / and stafi from and aqainst all th' responsibiriries, liabirities and regar implicarrons Ine or anv aw o/ and for the nme bernq rn iorce or othprw c" r. any manne.i in case of rhe test.€port goinq agar.st olr.hild. we, nereby indehnity l\4pcA Lom and aqainstaI trre civil cr p.oceedifgs / nifa and/or any legal case of o splre aqarnsr our

we are aware and hereby agree thar the property of the hedicat reports sha remain with the Mpcq dro we are bound to 'ollo* I e lsrrc-on,.e(e^ed tom lypcA,O,.r, hal CA based upon the medicat test reports. We sha not have any nght ro demand the originat/ photocopy ol the said repo(.

9, We are giving this affidavit to MpcA / Divisionat crtcket AssoctEtion Concer.ed / Hospibt with ruti undersiandinq N|PCA thal will at al times, in no way, tiable for a v dght or claih or compensation ' or anv lesal implication in anv rorum, o.qanJzaron or any kind ot on / ac.o!nt, at request by myseti, "ourt "n. hy spouse, child, ny oependants, nert Krn or orher of tesat representarivesi and no resal displtes of whatsoever nEture and whjchever taw rn t.dta any co!ntry shall be ctaimed / / todqed agai.st MpCA a.d others as above.

10 we herebv affi.m that, if round guiity of any of rhe prescribed / non prescribed acts actio.s / / rncioences erc., our ch d woltd be tiabJe lor appfoprtare acrion according to rltes / Regllatjons of lrpca / Divisionat crcket Asso.iation. without prqudice ro any other crihinat / non crimin:t acflon thar may be taken against thec -r'" -' ! !'ruchitd underunoer anv penal lau or anv law tor the tihe beinq in rorce,

11' we also herebv declare that we have carefurv read, thoroushry undersrood and aqree the conte.ts as above and have rakef efforts to understand the retter & spirit the essen.e of the various nofms mentio.ed above and do Eoree the same without to rurflir ahy burden / responsibjtity on / Divisiona/ cA / concerned Hospjtat ^tpca or any of its oificiats staff authorized representatjve. / /

Name & Dated Signat!re or the Father/ cuardiar

Name & O.red signat!re of rhe Nlother/ Guardiafl

Name & Dated signature of the ptayer

On ..,...... ,. d.y oi...... month of the year