18/21.05.2017 !##$%&'()*%+ - rally de portugal · oil spill kit order form 8 fuel order...
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rally guide 2www.rallydeportugal.pt
18/21.05.201718/21.05.2017
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appendixes 6 - forms
anexos 6 - formularios -
www.rallydeportugal.pt
18/21.05.201718/21.05.2017
Appendix 6 - Forms / Anexo 6 - Formulários
Accommodation Form / Formulário de Alojamento 1Service Park Application Form / Formulário de Pedido Especial Parque de Assistência 2Application Form Two-Way Radio / Formulário Rádio 3Reconnaissance Registration Form 4Registration Form Reconnaissance Only 5Helicopter Registration Form 6Additional Plate / Document Order Form 7Oil Spill Kit Order Form 8Fuel Order Form WRC 9
APPENDIX CONTENTS / ÍNDICE DE ANEXOS
2017 Accommodation Form / Formulário de Alojamento
Hotel
Twin / Duplo Arrival / Chegada Pax
Single Departure / Partida Basis
Credit Card / Cartão de Crédito
Visa MasterCard Eurocard American Express
Please complete this form and return to: Por favor complete este formulario e envie-o para:
ACP Viagens
e-mail: [email protected] - Tel. + 351 21 384 1072
Team / Equipa
Surname / Apelido Name / Nome
Country / País Fax
Mobile / Telemóvel e-mail
Card Nr. / Número
Good Thru / Validade
Card Holder / Titular
Amount / Total €
Date / Data Signature /
Assinatura
Service Park Application Form / Formulário de Pedido Especial Parque de Assistência
Team / Equipa:
Drivers / Pilotos:
Car Make: Marca:
Type / Modelo: Group, Class / Grupo, Classe:
Type of Entry / Tipo de Inscrição FIA Priority Driver / Piloto
Prioritário FIA
Yes / Sim – No / Não
Other / Outro
Yes / Sim – No / Não Cross out as appropriate / Assinalar com uma cruz o tipo
Reminder / Atenção Size of service area for competitors entered: / Dimensão do espaço de
assistência do concorrente inscrito:
10 x 10m (1 Car / 1 Carro)
10 x 20m (2 Cars / 2 carros)
10 x 10m (1 Car / 1 Carro)
10 x 15m (2 Cars / 2 carros)
For shared service space, please contact: / Para espaços de assistência comuns, contactar: [email protected]
Competitors are allowed to enter the Service Park from Monday 15th May at 09:00
Concorrentes são autorizados a entrar no Parque de Assistência a partir de segunda-feira 15 de Maio às 09:00
Service Vehicles / Viaturas de Assistência Make / Marca – Type / Modelo Qty / Qtd Length / Width / Registration Nº / Matrícula
Layout with dimensions (Mandatory) / Plano do espaço com dimensões (Obrigatório)
Facilities requested in the Service Park / Serviços Extra para o Parque de Assistência Event rental / Aluguer para o evento Price / Preço Delivery / Entrega Collect / Recolha Quantity / Quant. Total
Tota ADSL + Router 900,00€
Single VIP WC / WC VIP 150,00€
1 Daily Maintenance / Limpeza diária 25,00€
Country WC 2+1 (Trailer / Atrelado) 2.000,00€
1 Daily Maintenance / Limpeza diária 325,00€
Hospitality water drainage / Vazamento de água (1000L) 325,00€
Daily rental / Aluguer diário Price / Preço Transport / Transporte Delivery / Entrega Collect / Recolha Quantity / Quant. Total Fork Lift / Empilhador 2 ton 75,00€ 200,00 €
Forklift Telescopic / Empilhador Telescópico 6 mts
100,00 € 200,00 €
Forklift Telescopic / Empilhador Telescópico 14 mts
120,00 € 200,00 €
Scissor Lift / Tesoura 8 mts 60,00 € 200,00 €
Articulation Boom Lift / Plataforma Articulada 12 mts
80,00 € 200,00 €
Generator / Gerador 100 Kva 100,00 € 200,00 €
Other type of equipment contact [email protected] Please send this Form with proof of paument before 01.05.2017 to: Por favor envie este Formulário com comprovativo de pagamento até 01.05.2017 para: ACP - Motorsport (Automóvel Club Portugal – Motorsport Dept.) Rua General Humberto Delgado, nº3 – 2685-340 Prior Velho – Portugal Phone / Telefone: +351 21 942 91 87, Fax: +351 21 942 91 92 – Email: [email protected]
www.rallydeportugal.pt
2017 Application Form Two-Way Radio / Formulário Rádio 2017
Team / Equipa Contact person for license matters
Pessoa de contacto
Tel Fax e-mail Mobile
Requested frequencies / Frequências solicitadas
Full information concerning the address for delivery of the licenses
Morada completa para envio das licenças
Team address Morada da equipa
Team Hotel Hotel da Equipa
Other Outra
Please send this Application to: / Por favor envie este Formulário para: Vítor Guerreiro – Direcção Gestão do Espectro by: Fax: + 351 21 721 10 06 E-mail: [email protected]
www.rallydeportugal.pt
2017 Reconnaissance Registration Form
Any driver taking part in reconnaissance must respect the relevant regulations (see 2017 FIA WRC Sporting Regulations and 2017 Rally Vodafone Rally de Portugal Supplementary Regulations). Registration for reconnaissance will take place on Monday 15th May 2017 between 15:00 -21:00 at the Accreditation Centre – Exponor.
First Driver Co Driver
Surname:
Name:
Postal Address:
Date of Birth:
Mobile Number:
Email Address:
Licence Number:
Issuing ASN:
Driving Licence Number:
Issuing Country:
Details of the car
Make: Registration Number:
Model: Colour:
The undersigned acknowledge that they have duly read, understood and agree to be bound by the above terms and conditions:
Driver: Date:
Co-driver: Date:
www.rallydeportugal.pt
2017 Registration Form Reconnaissance Only
Any driver taking part in reconnaissance must respect the relevant regulations (see 2017 FIA WRC Sporting Regulations and 2017 Rally Vodafone Rally de Portugal Supplementary Regulations). Registration forms must be returned to Vodafone Rally de Portugal Secretariat by Friday 05th May 2016 the latest. The registration application will only be accepted if accompanied by the «Reconnaissance Only» fees or a receipt issued by the competitor’s National Sporting Authority. Registration for reconnaissance will take place on Monday 15th May 2016 between 15:00 -21:00 at the Accreditation Centre – Exponor.
First Driver Co Driver
Surname:
Name:
Postal Address:
Date of Birth:
Mobile Number:
Email Address:
Licence Number:
Issuing ASN:
Driving Licence Number:
Issuing Country:
Details of the car
Make: Registration Number:
Model: Colour:
The undersigned acknowledge that they have duly read, understood and agree to be bound by the above terms and conditions:
Driver: Date:
Co-driver: Date:
www.rallydeportugal.pt
2017 Helicopter Registration Form
POSSIBILITY FOR PATIENT TRANSPORT: yes: c no: cI, the pilot of the above helicopter, agree to follow the rules notified to me regarding the Rally. SIGNATURE:
HELICOPTER OWNER Helicopter’s Registration Company / Name
Type and Make Address Colours Phone
OPERATION What will be the use of the Helicopter on the Rally
Overnight Parking Location
PILOT
Name
E-mail Address (all info will be by e-mail)
Address and Phone
Address and mobile phone during the event
FLYING UNDER CONTRACT FROM
Name
Address
Phone
Payment should be done by Swift bank transfer:
Bank: BPI – Banco Português de Investimento NIB: 0010 0000 26738780006 57 Account Nr: 3-2673878.000.006 IBAN: PT50 0010 0000 2673 8780 0065 7 Swift: BBPIPTPL
Registration Fee: 2.460,00€ (VAT included) - Receipt compulsory - Cheques are not accepted
This application form should be completed and forwarded with Entry Fees receipt before: Wednesday 26th April 2017 Please send this application to: ACP – Motorsport (Automóvel Clube de Portugal – Motorsport Dept.) Rua General Humberto Delgado, nº3 2685-340 Prior Velho – Portugal Phone: +351 21 942 9187 - Fax: +351 21 942 9192 Email: [email protected] - Website: www.rallydeportugal.pt
2017 Additional Plate / Document Order Form
Please complete in block capitals
Contact Details
Contact Name
Company / Team Name
Tel No Fax No
Email address
Postal Address
Price Number Required
Auxiliary Plate 475,00 € Includes 3 Team Passes, 1 Route Map
Road Book 100,00 €
Total Payment Enclosed
Please complete this form and return it to: [email protected] until the 01.05.2017
OIL SPILL KIT Order Form Please complete in block capitals
Contact Details Contact Name
Company / Team Name /
Mobile phone no.
Email address Price Number Required
Oil Spill Kit 50,00 €
Total Payment Enclosed: _______________________________
Payment details:
Entity ACP - Automóvel Club de Portugal
Bank BPI - Banco Português de Investimento
BAN 0010 0000 26738780013 36
IBAN PT50001000002673878001336
SWIFT BBPIPTPL
Please complete this form and return it to: [email protected] the 01.05.2017. Oil Spill Kits will be delivered at the Secretariat at the beginning of the event.
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FUEL ORDER FORM WRC 2017
RACE:_____________________________
TEAM:_____________________________
DRIVER AND NUMBER PANTA MAX WRC RON 102
25 LT DRUMS (SHAKE DOWN) FUEL DISPENSED
PRICE PER LITRE: 5,00 € + VAT
PLEASE NOTE THAT:
In Italy 22% VAT is applicable to all Competitors. In France 20% VAT is applicable to all Competitors with the exception of French Teams.
In Spain 21% VAT is applicable to all Competitors. For all the other European destinations, 22% VAT is applicable only to Private Citizens, Italian Companies and non-
European Union Companies. For long haul events no VAT is applicable.
DETAILS FOR INVOICING
COMPANY NAME
VAT CODE
ADDRESS STREET CITY POST CODE
CONTACTS PHONE
FAX MOBILE
CONTACT PERSON
NAME E.MAIL