Red/Black Dot Entries

Model asserted:Model

FIA homologation form number (if FIA numberform applicable):homologation cm Engine type:Engine asserted:Make HISTORIC TECHNICAL PASSPORTVALIDIN: – TECHNICAL HISTORIC

CODE, FOR CARS TAKING PART IN HISTORIC COMPETITIONS. THIS CERTIFIED COPY OF THE ORIGINAL FORM REMAINS THE THE HOLDS REMAINS WHICH FORM ASN ISSUING THE ORIGINAL TO ORIGINAL. RETURNED THE BE MUST OF FORM, NEW COPY A WITH CERTIFIED REPLACED IF THIS AND, FIA THE COMPETITIONS. OF PROPERTY HISTORIC IN PART TAKING CARS FOR CODE, SPORTING INTERNATIONAL THE TO "K" APPENDIX WITH ACCORDANCE IN COMPLETED WAS DOCUMENT THIS OF ORIGINAL THE Period Issuing ASN: 2013 International HTP Date represented. model of andperiodspecificationthe make car complieswith belief, the and the We, the This Technical Passport is not a certificate of authenticity, nor does it in anyway verify the history of the car or its or car knowledge. available best his upon based owner the by the claimed those are "asserted" as below shown items The of the history for responsibility the takes or certifies verify ASN the number. chassis the of accuracy anyway nor FIA the in Neither vehicles. it historic for does events FIA-sanctioned in nor compete authenticity, to eligible of be to appeared car the inspection, the of certificate date the at that confirms merely Passport a Technical A parts. constituent not is Passport Technical This 3 vignette FIA FIA HTP Each page of this form, as well as the edge of each photograph, must bear the stamp of the issuing stamp ASN must of photograph,bear the of each the ofform, well edge this as Each page :

capacity:

DURING THE WHOLE EVENT THE CAR MUST CONFORM TO ALL THE DECLARATIONS OF THIS HTP. THIS OF DECLARATIONS THE TO ALL CONFORM MUST CAR THE EVENT WHOLE THE DURING : :

, have checked the information given on this form and confirm that to the bestknowledgetoof our confirm on andthe formthat the information this given , have checked A

cm to 3 COLOUR PHOTOGRAPHIN OF THE ITS CAR PRESENT FORM Form Number: FormNumber:

¾ front front Digital photograph resolution photograph of suitable Digital Signature and Signature stamp: and corrected: view ofviewthe valid31.12. to

ae o rgnl manufacture original of asserted: Date

9 cm x cm 9 13 cm x

side of the complete carthecomplete of side FIA FIA n°: identity Manufacturer asserted: form:homologation ofNumbervalid pages of relevant n°: VINVehicle/chassis

Category: HILL-CLIMB

FIA Class: Class: FIA ofstatusandsignatory:Name Single-Seater Racing CarSingle-Seater

& & specification: of Year

2013 International HTP

In homologatedIn non cars periodany case pictureshownmodela ofbelow. for the has to be Specification of bodyworkchanged toaccording Appendix stampedK, over by issuingauthorisation.the ASN as period. the of J Appendix to according onwards G Period from cars GTS and Touring Competition on and G Period before cars homologated of case In Appendix their K), numbersmust beentered below: only: car homologated of case In 2013 International HTP IMPORTANT : model has: this If F or the avoidance of any doubt there must be attached to this document evidence of Period of evidence document this to attached be must there doubt any of avoidance the or Period image. Event: ……………………………………; date of Event: the event:Period date ……………………………………; image. For others also display a picture from period, especially as it as period,canfrom it picture especially display a For also others COLOUR PHOTOGRAPHOFTHECOLOURCAR PRESENT IN FORMITS bodywork may only be altered on Competition Grand Touring Cars (GTS) Cars Touring Grand Competition on altered be only may bodywork PERIOD IMAGEOFPERIODOFBODYWORKORIGINAL CAR no International no History ¾ rear

if extensions of the original homologation form form homologation original the of extensions if resolution photograph of suitable Digital view of the view authenticate thecarlivery.authenticate Homologated cars.Homologated ……………………… 9 cm x cm 9 13 cm x 9 cm x cm 9 13 cm x left side of the complete carof sidethe complete

, , box:tick this Signatory ASN: Signatory are used are

(in accordance with accordance (in Formn°:

[n] ] [m [l] [k] [j] ] [i2 ] [i1 [h] [g] [f] [e] [d] [ [b] [a] [ [d] [ [b] [a]

1.2 1.1 2013 International HTP e] c] c]

If yes If toyes adjustable? thesuspension height Is of adjustable? suspension the geometry of Is Steel dampers: of the Material per adjusters numberdamper: state [f], of the If to yes dampers adjustable? theAre etc.): telescopic, dampers lever, Type (friction, of bar, spring etc.): leaf, torsion(coil, Type of de etc.): axle,wishbones, Dion, (rigidsuspension Type of Clarification: dimensions? the period theperspecifications and suspension as Is oncar: identification numbers ofthe position all Note Materials: tubular, (girder, etc.): monocoque, Construction Clarification: period tospecifications? chassisthethe with car fitted a Is If yes, list the sensors: sensors: theIf yes, list fitted? sensors Are this bar If adjustable? yes, is bar?it with anti-roll fitted an Is i2: i1: FRONT FRONT SUSPENSION FRAME CHASSIS

[i1] and/or [i2]

, specify the method (Uniball joints, different mountings, etc.): etc.): mountings, joints, different method (Uniballspecify , the 1 – CHASSIS, 1 CHASSIS, SUSPENSION – Aluminium

Signatory ASN: Signatory

yes yes yes yes yes yes yes yes Formn°:

no no no no no no no no no

2013 International HTP In case of drum brakes the drum has to be removed and seen on the the pictureberemoved seen on brakesthetoand drum of has drum In case wheel removed; the braking system and suspension must be clearly visiblemust suspensionbe clearly and thesystem braking removed; wheel behind the braking system in longitudinal axis of the car ofaxisthe car in thesystem braking longitudinal behind COLOUR PHOTOGRAPHOFTHECOLOURFRONTSUSPENSION PHOTOGRAPHOFTHECOLOURFRONTSUSPENSION Digital photograph resolution photograph of suitable Digital resolution photograph of suitable Digital 9 cm x cm 9 13 cm x 9 13cmx cm 9 Signatory ASN: Signatory

Formn°:

] [n m [ [l ] [k [j 2] [i 1] [i ] [h ] [g [f] ] [e ] [d ] [ ] [b ] [a

1.3 2013 International HTP c ] ]

Is the height of suspension adjustable? thesuspension height Is of adjustable? suspension the geometry of Is Steel dampers: of the Material per adjusters numberdamper: state [f], of the If to yes dampers adjustable? theAre etc.): telescopic, dampers lever, Type (friction, of bar, spring etc.): leaf, torsion(coil, Type of de etc.): axle,wishbones, Dion, (rigidsuspension Type of Clarification: period perspecifications? astheand suspension dimensions theAre If yes, list the sensors: sensors: theIf yes, list fitted? sensors Are this bar If adjustable? yes, is bar?it with anti-roll fitted an Is i2: i1: If toyes REAR SUSPENSION REAR

[i1] and/or [i2]

, specify the method (Uniball joints, different mountings, etc.): etc.): mountings, joints, different method (Uniballspecify , the Aluminium

Signatory Signatory ASN:

yes yes yes yes yes yes yes Form n°: Form n°:

no no no no no no no no

2013 International HTP In case of drum brakes the drum has to be removed and seen on the the pictureberemoved seen on brakesthetoand drum of has drum In case wheel removed; the braking system and suspension must be clearly visiblemust suspensionbe clearly and thesystem braking removed; wheel behind the braking system in longitudinal axis of the car of longitudinal the axis in behindthe system braking COLOUR PHOTOGRAPHOFTHECOLOURREAR SUSPENSION PHOTOGRAPHOFTHECOLOURREAR SUSPENSION Digital photograph resolution photograph of suitable Digital resolution photograph of suitable Digital 9 cm x cm 9 13 cm x 9 13cmx cm 9

Form n°: Form n°:

[r] ] [q ] [p ] [o ] [n m [ [l] ] [k [j] [ ] [h ] [g [f] ] [e ] [d ] [c ] [b ] [a

2.1 2013 International HTP i] Is the cylinder head cast using the period specification material and dimensions? material period specification the thecylinder cast using head Is Clarification: Specify material: and materialdimensions? periodspecification the thecast cylinder using block Is Clarification: period engineperspecifications? the of astheposition the Is Clarification: chassis? for as thethis engineper period specifications Is If yes, list the sensors: sensors: theIf yes, list fitted? sensors Are Clarification: to sizes period Valve specifications? engine): case (in of wankel/rotary of Number rotors engines): stroketwo case (in of of port Number transport ports: of Number exhaust ports: of Number intake capacity: Engine Bore: of Number cylinders: manufacture: Year of Make: Clarification:: Specify material:

ENGINE

actual: original:

original:

2 – ENGINE– 2 cm 3 Number of plugs per cylinder:of Numberplugs per Casting number: Casting Casting number of the numberblock: of Casting Stroke: Stroke: V, (straight,etc.): Configuration method: Operating

Number of valves per cylinder:of Number valves per

Signatory Signatory ASN: actual: actual: original:

Four-stroke cycle

no no yes yes yes yes

cm mm Form n°: Form n°:

3 mm yes yes no no no no no

] [l ] [k ] [j ] [i h [ ] g [ ] [f ] [e d [ ] [ ] b [ ] [a ] [f ] [e ] d [ ] [c ] b [ ] [a

2.3 2.2 2013 International HTP c

If yes, list the If yes, listsensors: fitted? sensors Are Clarification: asthe itper period isspecifications? airIf anfitted, is cooler Supercharger: Clarification: period perspecifications? asthethe supercharger If supercharged, is of the fitted, diameterrestrictor: airIf anis restrictor : Injection Type: Carburettor: Clarification: specifications? the/ period pernumber thetypeinjection as Are make, of and carburettors the If yes, listsensors: fitted? sensors Are the principal: specifymake If electronic, the and ignition is etc.):breaker/coil,Type (magneto, Clarification: period perspecifications? system Is asthe the FUEL FEED FUEL IGNITION

Number:

ø mm: of inventuri

Number: Type: Make:

Make: Signatory Signatory ASN: mm

yes yes Type: yes yes yes yes yes yes yes

Form n°: Form n°:

no no no no no no no

] [i h [ g [ ] [f ] [e d [ ] [ ] b [ ] [a ] h [ g [ ] [f ] [e d [ ] [c ] b [ ] [a

2.5 2.4 2013 International HTP c

If yes, list the If yes, listsensors: fitted? sensors Are cars only)? oil circuitfilter (pre-war mainfitted Is a period specification: to relation thein If specifyjustify no, changes and period specifications? percooler If as yes, isthe the fitted? Is oil an cooler Type (wet etc.): dry sump, sump, Clarification: period perspecifications? system Is asthe the the If yes, listsensors: fitted? sensors Are Clarification: with itAppendixDoes comply K? the location? fueltankperiod perspecification's Is as the fuelcooler fitted Is a pump, Type mechanical etc.): of (gravity, pump, fuel feed electric Clarification: period specifications? fuelsystemper Is as the the LUBRICATION SYSTEM FUEL

yes yes yes yes yes yes yes yes yes

yes yes yes yes Form n°: Form n°:

no no no no no no no no no no

2013 International HTP COLOUR PHOTOGRAPHOFTHE COLOURENGINEthe showingengine all bay COLOUR PHOTOGRAPHOFTHE COLOURENGINEthe showingengine all bay Digital photograph resolution photograph of suitable Digital resolution photograph of suitable Digital from theside fromright from the left side thefromleft 9 13cmx cm 9 9 13cmx cm 9 Signatory ASN: Signatory ASN:

Form n°: Form n°:

] [k ] [j ] [i h [ g [ ] [f ] [e d [ ] [c b [ ] [a ] [i h [ g [ ] [ ] [e d [ ] [c b [ ] [a

3.2 3.1 2013 International HTP f

If yes, list the If yes, listsensors: fitted? sensors Are period perspecifications? If yes, isasthe it fitted? Is oil an cooler If yes: slipdifferential? differential limitedIs the a asof teeth availableperiod thenumberspecifications: Specify other of theSpecify teeth used: number periodperspecifications? final Is ratio asthe the drive etc.): chain, Drive method (shaft, Driven wheels: the If yes, listsensors: fitted? sensors Are period perspecifications? If yes, isasthe it fitted? Is oil an cooler Constant: 1st of Numberteeth of gears: Numberforward Make: Clarification: specifications? gearbox asIs the the per period

FINAL DRIVE FINAL GEARBOX gear: gear:

Make: Make: (for homologated cars only) -

no no no no no 9section in listed alternatives 4th 2nd

gear: gear: -

Front:

3 TRANSMISSION –

Model: 5th 3rd :

reverse gear:reverse Type: - gear gear:

Rear: Rear: Signatory ASN: Signatory ASN: -

System: System: - 6th

- yes yes yes yes yes yes yes yes

Form n°: Form n°: -

- no no yes yes no no yes yes yes no no no no

g [ ] [f ] [e d [ ] [c ] b [ ] [a ] [j ] [i h [ g [ ] [ ] [e d [ ] [ ] b [ ] [a

4.2 4.1 2013 International HTP f c

If yes, list the If yes, listsensors: fitted? sensors Are theSpecify system: assisted?steeringIs the and etc.): Type worm andpinion, (rackroller, Clarification: asthe steering per period specifications? Is the the If yes, listsensors: fitted? sensors Are calliper: calliper: If disc brakes: brakes: If drum Make: theSpecify system: assisted?braking yes Is thesystem option:Other etc.):(cable, rod,Actuation hydraulic, Clarification: periodperspecifications? asthebraking Is thesystem STEERING BRAKES

Callipers: disc:Ventilated Max.thickness disc diameterDisc Other: Shoe width Other: Drum diameter

4 – BRAKES ANDSTEERING 4 BRAKES – mm mm Material at Material rear: atMaterial front: Front: Front: : Front Front: Front:

no Front: no Front: Rear: Rear:

Number of pistons per rear of Number pistons per front of Number pistons Signatory ASN: Signatory ASN:

mm yes yes Rear: Rear: Rear: Rear: Other option: Other

Rear: Rear: Rear: Rear:

no yes yes yes yes yes yes yes

Form n°: mm mm mm

no no no no no no no no mm

] [ ] b [ ] [a h [ g [ ] [f ] [e d [ ] [c b [ ] [a ] [j ] [i h [ g [ ] [ ] [e d [ ] [c b [ ] [a

6.1 5.1 2013 International HTP 6.2 f c

Measurements see extensionMeasurements Clarification: specifications? devices theseastheAre per period of Numberdoors: of Numberseats: coupé, Type etc.): (single-seater, parts: and bodymaterial material If other specify used Main material: specifications? of asthe the Is material per period bodyall Clarification: period perspecifications? body If isno, asthe the body that Is the one chassis? thefor original the If yes, listsensors: fitted? sensors Are the widths of Diameters at / rims the widths of Diameters at / rims Front: alloy,alloy,alu steel, magnesium etc.):pressed Type (wire, and material Clarification: period specification? widthperthe and the as wheels the Arethe diameter of the multiple parts? Arein wheels Clarification: period specifications? perthe Areas wheels the

3. 1. 3. 1.

AERODYNAMIC DEVICES AERODYNAMIC BODY WHEELS Diameter: Diameter: Diameter: Diameter:

" " " "

Width: Width: Width: Width: (cars built after 1965 builtonly) after (cars 6 – BODYWORK, LIGHTINGBODYWORK, – 6 “ AERODYNAMIC(MEASUREMENTS)” DEVICES

front rear

5 – WHEELS– 5 " " " " (specify the units: inches or millimetres): or inches (specifyunits: the (specify the units: inches or millimetres): theor inches (specifyunits: Rear: Rear:

4. 2. 4. 2. Diameter: Diameter: Diameter: Diameter:

" " " "

Width: Width: Width: Width: Width: yes yes yes yes yes yes yes yes yes Form n°: Form n°:

no no yes no no no no no no

" " " "

] [c ] b [ ] [a d [ ] [c b [ ] [a

If necessary, drawings and/or pictures of the aerodynamic devices, suspension, etc of and/or thedevices, pictures suspension, drawingsaerodynamic If necessary, 7.1 6.3 2013 International HTP etc) of (gearbox alternatives listratios, If necessary,

Minimum weight: Minimum weight: rear:Original front:Original - tyre treads):of between the the(measured centres - Track Wheelbase: If yes, type: Is generator fitted? period specification: to relation thein If specifyjustify no, changes and period lightingspecifications? per Is as the DIMENSIONS LIGHTING or Body centre at width dynamo

mm mm left: 9 – ADDITIONAL PIECES PIECES 9 ADDITIONALOF INFORMATION – kg 8 – DRAWINGS AND/OR PICTURES AND/OR 8 DRAWINGSPICTURES –

alternator alternator line mm of axles for homologated cars from Period G2 onwards onwards fromG2 of for Period axles cars homologated 7 – DIMENSIONS– 7 right: other, specifyjustify:other, and

Current rear: rear: Current front: Current mm Signatory Signatory ASN:

yes yes yes

Form n°: Form n°:

Licence number (if applicable):number (if Licence address: Full new car owner: of Name the applicable):number (if Licence address: Full new car owner: of Name the applicable):number (if Licence address: Full new car owner: of Name the applicable):number (if Licence address: Full car owner: of Name the the accuracy or otherwise of any information contained in this form. Such information has information Such form. this its responsible in solelyforaccuracy. who remains theof been supplied bytheowner car, contained not information has any of ASN otherwise The or accuracy inspection. the the of date the since for liability no accepts and above, specified that than other purpose any for modified car the inspected been have may car the and manufacture,original of time the at car this to fitted necessarily not to was specification original manufactured be (as to appears which Vehicles part a example, For Historic car. the of for history or the authenticity events guarantee to as FIA-sanctioned representation no makes in It Code). Sporting compete International the to in defined eligible be to appears car CAUTION: Date: BE IMMEDIATELY ANSWERS ASN W K have appendix priority. The of regulations current regulations:following comply with technical - the Or, car must - 2013 International HTP

The car must comply with the technical regulations for technicalGroup comply with regulations the The car must E

FILLED

CERTIFY

SHOULD

IN ARE

ACCORDING

CANCELLED This document is intended solely to verify that, at the date of the inspection, the inspection, the of date the at that, verify to solely intended is document This THAT

SHOWN ANY

CHANGES

TO ANSWERS

. W . TO

ALSO 11 – COMPETITOR’S – DECLARATION 11 COMPETITOR’S BE

INFORMATION

10 – TECHNICAL – REGULATIONS 10 GIVEN MADE 12 – CHANGE IN OWNERSHIPIN– 12 CHANGE CERTIFY

KNOWINGLY

. W . ARE

THAT E

CORRECT UTEMR FURTHERMORE GIVEN Signature:

INCORRECT

ENTRY , ,

THE AND

PRESENT

FORM WE

ACCEPT OR UNDERTAKE

INACCURATE

FORM Signatory Signatory ASN:

THAT FIA .

of Appendix TO

IF INTERNATIONAL

(from 19(from

NOTIFY THAT AT

LATER THE

HTP HTP J Form n°: Form n°:

19 AUTHORISING ).

EVENT DATE

WILL .

WILL OUR

Date RECORD T Appendix K. article toits 4.3 of refer conformityevent an HTP, not inwith is for If thepresented is car that 2013 International HTP HIS

ANY Venue ,

COMMENTS TO

FILLED

MADE Comments

SUBSEQUENT ONLY

BY 13 – ELIGIBILITYCHECKS – 13 I FIA

TO EVENT

SCRUTINEERING

OFFICIALS

AT AND FIA FIA

ONLY Signatory Signatory ASN: Signatory Signatory ASN: INTERNATIONAL

NECESSARY

the the official of status and Name

EVENTS Form n°: Form n°: Form n°: Form n°: , . SERVES

Date 2013 International HTP T HIS

TABLE Venue

COMPULSORY Comments (e.g. heavy damage after crash or safety errors) crashor after(e.g. safety heavy damage Comments

MAY 14 – LOG – BOOK 14

FILLED

BY S CRUTINEERS ( NOT FIA FIA official of the Signature OFFICIALS

ONLY )

2013 International HTP This extension is an addition to the basic Historic Technical Passport for non homologated for Technical Passport basicto extension Historic Thisis the addition an COLOUR PHOTOGRAPHIN OF THE ITS CAR PRESENT FORM COLOUR PHOTOGRAPHIN OF THE ITS CAR PRESENT FORM cars, for Group 5 cars and post-1992 GT carsGroup cars, 5 cars for and EXTENSION – NON HOMOLOGATED NON CARS EXTENSION – Digital photograph resolution photograph of suitable Digital resolution photograph of suitable Digital

Front Rear view of carviewthe the complete view of the complete of carthe view 9 cm x cm 9 13 cm x 9 cm x cm 9 13 cm x Signatory Signatory ASN:

Form n°: Form n°:

2013 International HTP COLOUR PHOTOGRAPHIN OF THE ITS CAR PRESENT FORM COLOUR PHOTOGRAPHOFTHECOLOURDASHBOARD Digital photograph resolution photograph of suitable Digital resolution photograph of suitable Digital lateral view of the complete of carthe view 9 cm x cm 9 13 cm x 9 cm x cm 9 13 cm x Signatory Signatory ASN:

Form n°: Form n°:

2013 International HTP COLOUR PHOTOGRAPHOFTHECOLOURCOMPLETEBOOT COLOUR PHOTOGRAPHOF THE UNDER FLOOR Digital photograph resolution photograph of suitable Digital resolution photograph of suitable Digital 9 cm x cm 9 13 cm x 9 cm x cm 9 13 cm x Signatory Signatory ASN:

Form n°: Form n°:

2013 International HTP COLOUR PHOTOGRAPHOFTHECOLOURFINAL DRIVE COLOUR PHOTOGRAPHOFTHECOLOURGEAR BOX Digital photograph resolution photograph of suitable Digital resolution photograph of suitable Digital 9 cm x cm 9 13 cm x 9 cm x cm 9 13 cm x Signatory Signatory ASN:

Form n°: Form n°:

(books, periodicals, etc.) contemporary with construction.contemporary its etc.)periodicals, (books, documents theinreferences to car found of and thelist descriptive technical up Draw a 2013 International HTP DOCUMENTARY REFERENCES DOCUMENTARY Signatory Signatory ASN:

Form n°: Form n°:

d [ ] [c b [ (mm) Wall thickness (mm) diameter Outer [a] ] [c b [ (mm) Wall thickness (mm) diameter Outer [a] ] [a ] [a ] [a

1.5 1.4 1.3 1.2 1.1 2013 International HTP 1.6

Number of mounting points bodyshell of chassis: Numbermountingto / of all used):options and drawings VI(including the toK - basic according App. App. numbers Drawing specification: Material of all used):options and drawingsdrawings VI(including the toK - basic according App. App. numbers Drawing specification: Material If extension: If on with:inSystem accordance certified by an certified ASNan by FURTHER INFORMATION, IF IF NECESSARY:INFORMATION,FURTHER SYSTEMSPECIFICATION PERIOD (SELF MADE)K SYSTEM APPENDIX SYSTEM CERTIFIED ASN SYSTEM FIA HOMOLOGATED OVER PROTECTION SYSTEMROLL FIA FIA homologation form N.B. Test report / number: Certificate N.B. form: of the Homologation number

: A copy of the extension must be attached to copytheof must :thebe to HTP. attached extensionA : A copy of the certificate must be attached to the HTP. tobe attached the copy of :must the certificate A Main/Lateral Main/Lateral EXTENSION – ROLL OVER PROTECTION SYSTEM PROTECTION ROLLOVER EXTENSION –

: bar bar

: Period Specification Specification (Appendix J) Period Name of the Name ASN: Name of Name manufacturer: Front bar Front bar Front

Diagonals Diagonals

Number of Numberthe homologation

Signatory Signatory ASN: Other strutsOther Other strutsOther

Cross braces Cross Cross braces Cross Form n°: Form n°:

] [E ] [D ] [C ] [B ] [A DIMENSIONS 2013 International HTP

mm mm mm mm mm (TOLERANCE FOR ALL DIMENSIONS: +/-1%) FOR (TOLERANCE ALL DIMENSIONS: EXTENSION – AERODYNAMIC DEVICES DEVICES – (MEASUREMENTS) AERODYNAMIC EXTENSION

Form n°: Form n°:

] [F ] [E ] [D ] [C ] [B ] [A 1 WING 2013 International HTP DIMENSIONS WINGS:NUMBER OF

mm mm mm mm mm mm (TOLERANCE FOR ALL DIMENSIONS: +/-1%) FOR (TOLERANCE ALL DIMENSIONS:

[F] [E] [D] [C] [B] [A] WING 2

mm mm mm mm mm mm [F] [E] [D] [C] [B] [A] WING 3

Signatory Signatory ASN: mm mm mm mm mm mm

Form n°: Form n°:

[J] [I] ] [H ] [G ] [F ] [E ] [D ] [C ] [B ] [A ] [M ] [L ] [K [J] [I] ] [H ] [G ] [F ] [E ] [D ] [C ] [B ] [A DIMENSIONS: +/-1%) FOR ALL (TOLERANCE DIMENSIONS DIMENSIONS: +/-1%) FOR ALL (TOLERANCE DIMENSIONS 2013 International HTP min. min. max. min.

50 50 mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm

Form n°: Form n°: