Vereniging Profboksen Nederland (VPBN)

Profboksen Nederland (PBN) (Association for Professional Boxing in the Netherlands member of the European Boxing Union)

AUTHORISATION TO FIGHT ABROAD

Name of opponent : Duration of contest : City & Country : Date of contest : Date of authorisation : TO WHOM IT CONCERNS

Please accept this letter as the authorisation that :

is a licensed boxer of PBN and that he has permission to take part in above mentioned contest having fulfilled all medical requirements according to (international) European Boxing Union-rules.

We further confirm that the manager of above mentioned Dutch licensed boxer has confirmed that his boxer is insured by Dutch law as a Dutch citizen.

Please advise us of the result of the contest by sending the result by e-mail to [email protected]

Weight of the Dutch boxer:…………………………

Weight of opponent :…………………………

SCHEIDSRECHTERVERKLARING - DECLARATION REFEREE - CERTIFICATION ARBITRE

WINNAAR ) OP ) WINNER ) ...... ON) ...... VAINQUEUR ) A )

OPMERKINGEN )……………………………………………………………………………………………………………………………………. REMARKS ) OBERSERVATIONS ) …………………………………………………………………………………………………………………………………….

de scheidsrechter / the referee / l’arbitre

name:…………………………………………………………. signature:

All correspondence should be forwarded to the address mentioned below. Correspondentie PBN s.v.p. richten aan het secretariaat: Medemblikhof 73 - 6843 BW Arnhem - Nederland -  (31)(0)26-3811406 - E-mail: [email protected] Ingeschreven in de Kamer van Koophandel: H 27242806 * Rabo bank 34.47.63.528