MSA Form Ref: Tech/2008/001A Reference:. .

SCRUTINEER’S NON-COMPLIANCE REPORT

Organising Club Date:

Venue: Permit Number:

Type of Event Formula/Class:

Entrant/Competitor Name: Comp. No.:

This is to advise the Clerk of the Course that the subject vehicle does not comply with class regulations
as detailed below:

Heat/Final No: Chassis No: Engine No:

Description of Non-Compliance: Regulation Reference(s):

Chief Scrutineer/Technical Commissioner: Technical Commissioner/Eligibility Scrutineer:

Signature: Signature:

Name: Name:

Licence No: Licence No:

Date: Time: Date: Time:

I/We (Driver/Parent/Entrant/Guardian)*:
Signature(s)

Agree/Do not agree* that vehicle no.: fails to comply with the regulations listed above.
Sealing Information (where applicable):

Seal Type: No.: Located:

Signature: Name:
Clerk of the Course:

Signature: Name:

Date: Time: Licence No.:

* Delete as appropriate
Copies to:
Chief Scrutineer ; Clerk of the Course ; Entrant 