<p> Profboksen Nederland (PBN) (Association for Professional Boxing in the Netherlands member of the European Boxing Union)</p><p>AUTHORISATION TO FIGHT ABROAD</p><p>Name of opponent : Duration of contest : City & Country : Date of contest : Date of authorisation : TO WHOM IT CONCERNS</p><p>Please accept this letter as the authorisation that : </p><p> 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.</p><p>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.</p><p>Please advise us of the result of the contest by sending the result by e-mail to [email protected] </p><p>Weight of the Dutch boxer:…………………………</p><p>Weight of opponent :…………………………</p><p>SCHEIDSRECHTERVERKLARING - DECLARATION REFEREE - CERTIFICATION ARBITRE</p><p>WINNAAR ) OP ) WINNER ) ...... ON) ...... VAINQUEUR ) A )</p><p>OPMERKINGEN )……………………………………………………………………………………………………………………………………. REMARKS ) OBERSERVATIONS ) …………………………………………………………………………………………………………………………………….</p><p> de scheidsrechter / the referee / l’arbitre</p><p> name:…………………………………………………………. signature:</p><p>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</p>