RACEPACK AUTHORIZATION LETTER / SURAT KUASA RPC

To whom it may concern, I,

the undersigned,

No Name BIB (Filled by official)

hereby giving the authorization to:

Name :
ID number :
(KTP/KTM/SIM/PASSPORT/KITAS/KIMS) to collect my Race Pack on my behalf.
Along with this letter are the required documents for the Race Pack Collection: Printed
confirmation document Photocopy of ID all runners stated in this letter
(KTP/KTM/SIM/PASSPORT/KITAS)
Before collecting the race pack, my representation will present a photo identification for
verification purposes. I understand that the absence of any of the items mentioned above,
the event committee has the right to decline my race pack collection under any
circumstances. With this I declare this Authorization Letter, along with the supporting
documents are confirmed and true.

Regards,
[Participant’s signature] [Date]

# Attorney Letter is only valid for Non Ultra Category.