No 6A, Jalan Teknologi 3/5, Pusat Teknologi Sunsuria PJU5

Kota Damansara, 47810 Petaling Jaya, Malaysia

FAX: +603 6151 1715
VENUE : U
EVENT DATE : _________________
ROUND : __________________


Drivers
Name:
Address:
Email:


Team/Tuner
Make
Tire
(Brand & Model)

Category
(Tick the category
participating in)



Special KEI
Street Tuned
CLUB: ____________________________________________________________________
Payment :


Safety

No 6A, Jalan Teknologi 3/5, Pusat Teknologi Sunsuria PJU5
SNF Touge 2014
ENTRY FORM


UniMAP / MIMC / ELITE
__________________
: __________________
DRIVER/RIDER

NRIC/
Passport No:




H/P No:
VEHICLE
Model
Super 1500
Street Tuned Open, VTEC & Turbo
____________________________________________________________________

For Official Use:
Safety: Scrutineer:
Competition Number
1

Open, VTEC & Turbo
____________________________________________________________________

Competition Number



No 6A, Jalan Teknologi 3/5, Pusat Teknologi Sunsuria PJU5
Kota Damansara, 47810 Petaling Jaya, Malaysia
FAX: +603 6151 1715

INDEMNITY, WAIVER AND DECLARATION FORM

I hereby make an application to participate in this Event and certify that my particulars as given are

Declaration

I am fully conversant with the risks associated with motorsport in general and this event organised by Matrix Motorsports Pro
is potentially dangerous and uses roads that involve risk. I understand that participation can lead to injury even leading up
accept these risks completely and indemnify the organisers in the following p

I have read the Regulations issued for this event and agree to be bound by them. In consideration of the acceptance of my en
harmless and keep indemnified the Organisers and The Promoter, these being
agents, representatives, employees and all persons assisting them in this event and all owners and tenants of private propert
actions, claims, cost, expenses and demands in respect of death or injury to myself or any other person or persons or loss o
concerned in this event and tests, if any or otherwise howsoever and not withstanding that the same may have been contributed to or occasioned by the efforts, consequential
or otherwise, of the organisers and their officials, agents, representatives, employees and all persons assisting them in thi
executors and legal representatives. For the part of the event run on public roads I declare I have the necessary insurance w
Organisers, Promoters, and all related personnel from all liability whatsoever.

I declare that I, the driver, possess the standard competence necessary for an event of this type to which this entry relates
will be reached. I agree and undertake to abide by the Rules and Regulations framed for this event including the conditions precedent set out therein and all other Rul
Regulations which may hereinafter be framed.

I accept that though every effort will be made for ensuring my safety it may n

i) to ensure evacuation to nearest medical care after an accident will be undertaken with a lifesaving ambulance but surely with
quickest, irrespective of their quality of comfort etc
ii) to provide advanced surgery and health care facilities on the route itself, and evacuation to the nearest medical facility m
iii) to stop event traffic instantly in order to start an evacuation against oncoming cars,
iv) to guarantee that no oncoming traffic may be the cause of injuries to my person,

I/ We are not suffering from any bronchial diseases like asthma, hypertension, haemophilia or epilepsy
associated with the effects of High Altitude and accepting any risks and resultant consequences thereof. We also understand that the consumption
psychotropic substances are not permitted on the event and we agree to be excluded from the event if found, dur
above.

I/We agree and undertake not to agitate, litigate or seek the decision of a Court of Law on any matter of question concerning
submission of the entry up to the conclusion of the event and declaration or distribution of awards.

I/We will bear all cost incurred should any damages be inflicted onto the facility and circuit during the course of the event

Finally I/We hereby acknowledge that I/We am/are fully conversant with the risk and dangers, including injuries leading up to death,
particular which I/We assume hereby.


Driver Particulars:

Name:

IC No: ......................................


IMPORTANT:-

Any indemnity and/or declaration as prescribed by the paragraphs above if signed by a person under the
guardian whose full name and address shall be given:

Name of Parent/Guardian :



No 6A, Jalan Teknologi 3/5, Pusat Teknologi Sunsuria PJU5


INDEMNITY, WAIVER AND DECLARATION FORM
I hereby make an application to participate in this Event and certify that my particulars as given are correct, and agree to be bound by the undertaking on this form.
I am fully conversant with the risks associated with motorsport in general and this event organised by Matrix Motorsports Promotion Sdn Bhd specifically. I accept that this event
is potentially dangerous and uses roads that involve risk. I understand that participation can lead to injury even leading up to death as a result of my participation and I / we
accept these risks completely and indemnify the organisers in the following para against any claim made whatsoever.
I have read the Regulations issued for this event and agree to be bound by them. In consideration of the acceptance of my entry, to take part in this event, I agree to save
and The Promoter, these being Matrix Motorsports Promotion Sdn Bhd and their officials, the Government, the Sponsors,
agents, representatives, employees and all persons assisting them in this event and all owners and tenants of private property traversed by this event, from and against all
actions, claims, cost, expenses and demands in respect of death or injury to myself or any other person or persons or loss or damage to any property including the car
rwise howsoever and not withstanding that the same may have been contributed to or occasioned by the efforts, consequential
or otherwise, of the organisers and their officials, agents, representatives, employees and all persons assisting them in this event. The indemnity shall be binding on my heirs,
executors and legal representatives. For the part of the event run on public roads I declare I have the necessary insurance which covers me and thereby absolve the
nel from all liability whatsoever.
I declare that I, the driver, possess the standard competence necessary for an event of this type to which this entry relates, having regard to the course and the speeds which
abide by the Rules and Regulations framed for this event including the conditions precedent set out therein and all other Rul
I accept that though every effort will be made for ensuring my safety it may not always be possible to undertake the following:
to ensure evacuation to nearest medical care after an accident will be undertaken with a lifesaving ambulance but surely with
quickest, irrespective of their quality of comfort etc,
to provide advanced surgery and health care facilities on the route itself, and evacuation to the nearest medical facility may take any number of hours ,
to stop event traffic instantly in order to start an evacuation against oncoming cars,
that no oncoming traffic may be the cause of injuries to my person,
I/ We are not suffering from any bronchial diseases like asthma, hypertension, haemophilia or epilepsy and are taking part in the Event after understanding the risks
effects of High Altitude and accepting any risks and resultant consequences thereof. We also understand that the consumption
psychotropic substances are not permitted on the event and we agree to be excluded from the event if found, during the actual running of the event, to have consumed the
I/We agree and undertake not to agitate, litigate or seek the decision of a Court of Law on any matter of question concerning or relating to the Event commencing from the
entry up to the conclusion of the event and declaration or distribution of awards.
I/We will bear all cost incurred should any damages be inflicted onto the facility and circuit during the course of the event as a result of any incident or crash.
I/We hereby acknowledge that I/We am/are fully conversant with the risk and dangers, including injuries leading up to death, that are prevalent in Motor Sports in
Signature of the Driver, dated:

..

Any indemnity and/or declaration as prescribed by the paragraphs above if signed by a person under the age of 18 years, shall be countersigned by that person's parent or
..
2
correct, and agree to be bound by the undertaking on this form.
motion Sdn Bhd specifically. I accept that this event
to death as a result of my participation and I / we
try, to take part in this event, I agree to save
Matrix Motorsports Promotion Sdn Bhd and their officials, the Government, the Sponsors,
ed by this event, from and against all
r damage to any property including the car
rwise howsoever and not withstanding that the same may have been contributed to or occasioned by the efforts, consequential
. The indemnity shall be binding on my heirs,
hich covers me and thereby absolve the
, having regard to the course and the speeds which
abide by the Rules and Regulations framed for this event including the conditions precedent set out therein and all other Rules and
to ensure evacuation to nearest medical care after an accident will be undertaken with a lifesaving ambulance but surely with whatever means that are
ay take any number of hours ,
and are taking part in the Event after understanding the risks
effects of High Altitude and accepting any risks and resultant consequences thereof. We also understand that the consumption of alcohol and/ or
ing the actual running of the event, to have consumed the
or relating to the Event commencing from the
as a result of any incident or crash.
that are prevalent in Motor Sports in
age of 18 years, shall be countersigned by that person's parent or