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2014 FIA JUNIOR WRC CHAMPIONSHIP FOR DRIVERSAPPLICATION FORM

The FIA Junior WRC Championship is organized by the Federation Internationale de l’Automobile in cooperation with CITROËN RACING.

Drivers seeking to enter the 2014 FIA Junior WRC Championship for Drivers must complete and sign this application form and return it to CITROËN RACING.

Successful applicants will be notified in writing and offered an entry into the 2014 FIA Junior WRC, but an entry in the FIA Junior WRC is always conditional on the drivers signing the Junior WRC commercial agreement provided by CITROËN RACING regarding the supply of the car for the events in the FIA Junior WRC calendar with the appointed car supplier, CITROËN RACING. This commercial agreement must be signed within 2 weeks of receipt or the offer of a place in the FIA Junior WRC will lapse.

DETAILS OF THE APPLICANT / DRIVER

Name: ..........................................................................................................

First name: .........................................................................................................

Country: ...........................................................................................................

Address: ...........................................................................................................

Postcode: ...........................................................................................................

City: ...........................................................................................................

Currency: ...........................................................................................................

SIRET N°: ........................................................................................................... (if French Company)

VAT N°: ...........................................................................................................

Payment Condition: ...........................................................................................................

Tel : ...........................................................................................................

Mobile: ...........................................................................................................

Fax : ...........................................................................................................

E-mail : ...........................................................................................................

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PERSONAL DETAILS

Date of birth: ...........................................................................................................

City & Country of birth: ...........................................................................................................

Nationality: ...........................................................................................................

Country of residence: ...........................................................................................................

Website: ...........................................................................................................

□ Male □ Female

LICENCE DETAILS

Competition licence number: ...........................................................................................................

Issuing ASN: ...........................................................................................................

SIZES

CITROËN RACING pack for Driver : 1 overall, 1 set underwear , 1 shirt, 2 tee shirt, 1 hat, 1 rain Jacket, 1 bag.

Driver □ S □ M □ L □ XL

Driver overall Sabelt : Size 46, Size 48, Size 50, Size 52, Size 54, Size 56, Size 58, Size 60, Size 62 ,Size 64,

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DETAILS OF THE CO-DRIVER

Name: ..........................................................................................................

First name: .........................................................................................................

Country: ...........................................................................................................

Address: ...........................................................................................................

Postcode: ...........................................................................................................

City: ...........................................................................................................

Currency: ...........................................................................................................

Tel : ...........................................................................................................

Mobile : ...........................................................................................................

Fax : ...........................................................................................................

E-mail : ...........................................................................................................

PERSONAL DETAILS

Date of birth ...........................................................................................................

City & Country of birth ...........................................................................................................

Nationality ...........................................................................................................

Country of residence ...........................................................................................................

Website ...........................................................................................................

□ Male □ Female

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LICENCE DETAILS

Competition licence number ...........................................................................................................

Issuing ASN ...........................................................................................................

SIZES

CITROËN RACING pack for Co-Driver : 1 overall, 1 set underwear , 1 shirt, 2 tee shirt, 1 hat, 1 rain Jacket, 1 bag.

Co- Driver: □ S □ M □ L □ XL

Co-Driver overall Sabelt : Size 46, Size 48, Size 50, Size 52, Size 54, Size 56, Size 58, Size 60, Size 62 ,Size 64,

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DETAILS OF THE COMPETITOR (IF DIFFERENT FROM THE DRIVER)

As per WRC Appendix VIII Article 2.1.1, a driver may participate in the qualifying rallies under a competitor's licence hold by a team, sponsor or ASN designated team.

If so, please indicate below the competitor's details.

Company name: ..........................................................................................................

Country: ..........................................................................................................

Address: ..........................................................................................................

Postcode: ..........................................................................................................

City: ..........................................................................................................

Currency: ..........................................................................................................

Vat number: …………………………………………………………………………….

Contact name: ..........................................................................................................

Tel: ...........................................................................................................

Mobile: ...........................................................................................................

Fax: ...........................................................................................................

E-mail: ...........................................................................................................

LICENCE DETAILS

Competitor's name: ..........................................................................................................(as shown on the competitor's licence)

Competitor licence number: .......................................................................................................

Issuing ASN: .......................................................................................................

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DETAILS OF A PROJECT MANAGER

If correspondence must be sent to a project manager on behalf of the applicant, please provide his/her details below:

Name ..........................................................................................................

Tel ...........................................................................................................

E-mail ...........................................................................................................

ATTACHMENTS AND REQUIREMENTS

□ Driver Profile: The Driver Profile must be completed and enclosed.

□ Application Fee Form: A fee of € 3000 must be paid before an application can be considered.

DECLARATION

I confirm that I have read and understood the provisions of the FIA’s International Sporting Code, the Technical Regulations applicable to the group of cars scoring points in the 2014 FIA Junior WRC Championship, the 2014 FIA World Rally Championship Sporting Regulations.

I agree to be bound by them (as supplemented or amended) and furthermore I agree on my own behalf and on behalf of everyone associated with my participation in the 2014 FIA Junior WRC to observe them.

I confirm that I am born on or after 1 January 1986, that I have not competed in a WRC event with P1 status and that to the best of my knowledge I am eligible and able to compete in the 2014 FIA Junior WRC Championship.

The Applicant acknowledges and agrees that all rights, title and interest in connection with the FIA World Rally Championship, including without limitation all copyrights, database rights, and any and all related rights and neighbouring rights, audio-visual rights, domain name rights, trade name and trade mark rights including “FIA”, “World Rally”, “World Rally Championship”, “WRC” and “FIA World Rally Championship” (and any translation or permutation thereof), together with any associated goodwill vested therein are the exclusive property of the FIA. Any use of such rights by the Applicant other than for the purposes agreed by FIA (or its nominee) in writing is not permitted.

As per Appendix IX of the 2014 WRC Sporting Regulations, the Applicant also acknowledges and agrees that the FIA (or its nominee) may create and use any recording or replication of the Applicant taking part in events of the FIA World Rally Championship (including the image, logo, livery, colours, name, word mark and likeness of the Applicant’s team, car, uniforms, driver(s) and team members, as well as the name and logos of team sponsors present within Applicant’s livery) in any form without any need for consent, license or payment, for any and all purposes that are in the interest of promoting the FIA World Rally Championship. Such use shall be extended to any broadcaster, media partner, championship sponsor or licensee at the FIA’s (or its nominee) sole discretion. Such use shall include (but not be limited to) audio-visual recordings, photographs, all forms of editorial coverage, information guides, promotional items, interactive games and any item featuring the Applicant alongside 2 other participants in the FIA World Rally Championship. The FIA (or its nominee) shall ensure that such use shall always provide a fair, impartial and accurate representation of the Applicant and not imply or suggest the

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Applicant’s endorsement of a product or service. The FIA (or its nominee) shall make reasonable efforts to adhering to relevant branding guidelines as may be issued by the Competitor.

As per Appendix 6 of the Sporting Regulations, the Applicant should benefit from a list of services to be provided by the FIA and Event Promoters.

I declare that I have examined this Registration Form and that the information given is true, correct and complete.

FULL NAME OF APPLICANT ...........................................................................................................

SIGNATURE ...........................................................................................................

DATE ...........................................................................................................

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DRIVER PROFILE (1/2)

PERSONAL PROFILE

Tell us about yourself

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

CAREER PROFILE

First rally

...................................................................................................................................

Major achievements in rally

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

Major achievements in other motor sports

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

Major achievements outside motor sports

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

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Picture


DRIVER PROFILE (2/2)

ASN PROGRAMME

Are you a part of a national talent program by your ASN: □ Yes □ No

If yes, please provide contact details of the program manager

Name :..........................................................................................................................

Tel :...............................................................................................................................

E-mail :...........................................................................................................................

2013 PROGRAMME Details of your rally program in 2013

Year Rally Car Result (Overall & Class)

WRC RECORD List all WRC Rallies that you have started (as driver or co-driver)

Year Rally Car Result (Overall & Class)

PLANS FOR 2014 Events that you intend to/hope to contest in addition to the FIA WRC Junior Championship------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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APPLICATION FEE - PAYMENT FORM

The application fee for the FIA Junior WRC Championship is €3,000. It can be paid by bank in accordance with the information below.

Successful applicants will be offered a place in the 2014 FIA Junior WRC Championship. Others will have this application fee refunded.

Please note that application fees will not be refunded if an applicant withdraws from the FIA Junior WRC Championship after having been offered a place.

FOR PAYMENT BY BANK

Payment of the Application Fee must be made to the following bank account and a copy of the proof of payment must be attached to this application.

BANK DETAILS

NATIXIS PARIS (99999)30, AVENUE PIERRE MENDES-FRANCE75013 PARISFRANCE

ACCOUNT OWNER

AUTOMOBILES CITROENC/O PSA PEUGEOT CITROENPOLE TERTIAIRE10 BD DE L'EUROPE78300 POISSYFRANCE

IBAN: FR76 3000 7999 9904 0157 1200 067BIC : NATXFRPPXXX

Compulsory Purpose of Transfer: 2014 JUNIOR WRC [Applicant Name Only]

CITROËN RACING details Address:

CITROËN RACING19, Allée des Marronniers78035 - VERSAILLES CedexFRANCE E-mail: [email protected]

1) Complete and sign Application form, driver profile2) Send it to CITROËN RACING , to the attention of Jean-Francois LIENERE3) Do the payment and send bank confirmation to [email protected]

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mailto:[email protected]

mailto:[email protected]


4) You receive the invoice for application fee, sent by CITROËN RACING

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