kVµï >tµ ! Govt.Regd No : 29/2018 káìï >uïV©AÂïçé !! TM céï EéDÃD >uïV©AÂïçé ÄD¼\eªD WORLD SILAMBAM FEDERATION AN ISO 9001 : 2018 CERTIFIED SILAMBAM FEDERATION

Managed by : International Martial Arts Trust Member & Recognized by : ICSSPE - TAFISA & UNESCO Under the to Recognized by International Olympic Committee ...... céï ¶«ºþ_ *õ|D Îò T«Ý>twM[ ïçé ...... Phone : +91 9787699736 Email : [email protected] Website : www.silambamwsmaf.com APPLICATION FORM FOR COLOUR / BLACK GRADING FORM

Name of Applicant : ...... (in Capital Letter) Address : ......

Date of Birth : Blood Group :

Tel No.(Res) : ...... of : ...... Email :......

Academy : ......

Name of the Instructor : ...... R egistration No : ......

Date of Joining: ...... Date of Last Grading : ...... Exam Fees : ...... The exam fee must be paid before Along with the filled entry form. Rules and Regulation 1. I/My ward here by declare that the above mentioned information are true and correct. 2. I/My ward undertake to abide by the decision of Master.K.Jeevanantham 6th and Karate I.Sankar 5th Dan Chief Instructors of WSMAF - India regarding eligibility to appear for the test. 3. I/My ward understand that the decision of chief instructor will be binding regarding acceptance / rejection of the application. 4. I/My ward understand that the acceptance of this application do not imply / guaranteed Success in the rest. 5. I/My ward promise to pay the required test fee as informed before one month of the test. 6. I/My ward understand the test not being refundable under any circumstances. 7. I/My ward understand that the disciplinary action may be taken against me / My ward including cancellation of certificate dis missed from Academy etc... if /My ward fail to abide by the rules and regulation of association. I HAVE NO OBJECTION FOR THE ABOVE MENTIONED STUDENT APPEARING FOR HIS / HER TEST Place :...... Date :......

Signature of Parent / Guardian Signature of Instructor For office use

Final Result : Pass / Retest / Fail Signature of All India Chief Instructor & Examiner