Registration for Driver Selection JK Tyre Volkswagen Polo R Cup India 2012 .

Please fill the form using BLOCK LETTERS only

Applicant Registration No:

Name of the applicant: License no.: ASN: (For Official Use) (If driver is below 18 years of age applicant is legal guardian)

FMSCI sponsor card (if available): License no. FMSCI sponsor card Driver Last Name: ASN: (Nat. Automobile Club) Date of birth: Email address: Telephone: Mobile no: Address for correspondence: Fax:

First name: License no.: Nationality: A B C

_________________________ Signature of Applicant

________________________ Signature of Driver

For Official Use:

IMPORTANT INSTRUCTIONS WHILE FILLING FORM 1) FOR DRIVERS WHO ARE BELOW 18 YEARS OF AGE, DRIVER WILL BE HIM / HER SELF WHILE APPLICANT SHOULD BE HIS / HER LEGAL GUARDIAN. 2) FOR DRIVERS WHO ARE 18 YEARS AND ABOVE, DRIVER AND APPLICANT WILL BE THE CANDIDATE HIM / HER SELF.

3) DRIVERS WHO DO NOT HAVE A FMSCI SPONSOR CARD PLEASE FILL NA 4) DRIVERS, WHO DO NOT HAVE RACING LICENSE, PLEASE LEAVE THE ASN AND LICENSE SECTION BLANK.

5) DRIVERS WHO HAVE A VALID RACING LICENSE, PLEASE MENTION THE LICENSE NO AND GRADE OF LICENSE. 6) ALL ARE REQUESTED TO PLEASE PROVIDE ATLEAST TWO TELEPHONE NOS.

7) ADDRESS HAS TO BE COMPLETE WITH PIN CODE. 8) INCOMPLETE FORMS WILL NOT BE CONSIDERED. 9) DRIVERS NEED TO SEND THE SCANNED COPY OF THE SIGNED REGISTRATION FORM TO polocup@volkswagen.co.in & ALSO MARK A COPY TO anand.iyer@volkswagen.co.in & extern.suvjeet.bhowmik@volkswagen.co.in

10) THE SIGNED HARD COPY NEEDS TO BE COURIERED TO Suvjeet Bhowmik, Motorsports Department, Volkswagen India Pvt Ltd, E1, MIDC Industrial Area, Phase 3, Village: Nigoje Mhalunge, Kharabwadi, Tal: Khed, Chakan, Pune 410501

11) FOR FURTHER QUERIES PLEASE FEEL FREE TO MAIL US

-2-