Volkswagen Polo Cup 2011

REGISTRATION FORM

Name of the applicant

Applicant (signature on page):

Registration No.

Driver

Name: First name:

Street: Postcode, Residence:

Date of birth: Nationality:

Email address:

Telephone (d.): Fax (d.):

Mobile no. Telephone (p.):

Fax (p)
The registration fee will be paid by cheque by DD by Cash

Address for correspondence:

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 General contract declarations by the applicant and driver:

Applicants and drivers must accept the facts in the person or the behaviour of the team member
(applicant, driver, mechanic, assistant, etc.) that affect the contractual relationship with the
organiser. Applicants and drivers are responsible as joint debtors for the all obligations in the entry
contract.
Applicant knows that Motorsport is a dangerous activity, and minor or major injuries, permanent
disability and/or death may happen. The applicant is at his own risk.

Applicants/drivers assure that:

- the details represented in the entry form are correct and complete,
- the driver has fulfilled all the requirements of the racing events,
- the driver complies with all the points of the technical regulations and is in agreement with
their contractual obligation and implied declarations,
- they will use the vehicle only in a technically and visually sound condition during the event.

Declarations by the applicant and driver for exclusion of the liability

The participants participate in the test events and events keeping in mind the special risks involved
in motor sport and at their own risk.

They shall assume full civil and criminal responsibility for any damage caused by them or the
vehicles they have used, unless exclusions of liabilities were agreed upon.

When submitting the entry form, applicants and drivers renounce their right to claim any damages,
of whatsoever nature in connection with this event and/or the official season introductory course
and also against:

the FIA, the FMSCI and/or its affiliated organisations, its presidents, executive bodies,
managing directors, secretary generals, voluntary and full-time staff

VW India Private Limited, its subsidiaries, Volkswagen Motorsport India , their presidents,
executive directors, managing directors, secretary generals, members, voluntary assistants and
full-time employees

the promoters / event organisers and event sponsors

the organiser, the sports managers and assistants, race-track owners, government agencies,
racing services, manufacturers and all other persons involved in the organisation of the event,

any agents or other persons employed on behalf of all the above-mentioned persons and
authorities
except for damage due to harm to life, body or health resulting from the intentional or grossly
negligent breach of duty by the group of persons released from liability, including a legal
representative or agent of the group of persons

The exclusion from liability shall become effective for all parties concerned upon acceptance and
signing of this declaration by applicants/ drivers.

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 The waiver of liability applies to claims for any legal reason whatsoever, particularly to claims for
damage based on contractual and non-contractual liability and also to claims from an unlawful act.

Implied exclusions from liability shall remain unaffected by the above non-liability clause.

On submitting the entry form, the applicant/keeper/driver takes note that the insurance cover is
not provided within the scope of the automobile insurance (automobile liability, comprehensive
liability) for any damage during the event.

Should any injury occur or be discovered during an event or in case of health impairments which
may temporarily or permanently jeopardise the ability to drive a racing car, the undersigned
releases all attending physicians from medical confidentiality with respect to the responsible event
officials (the Medical Officer, the Clerk of the Course, the Steward of the Meeting), in view of the
safety risks this may pose to third parties.

Indemnity:

At all times during and after the term of this Agreement, the Applicants/Drivers and their legal
representatives agree to indemnify or to cause to be indemnified, defend and hold harmless (i)
Volkswagen India Private Limited (ii) and its respective directors, officers and employees from and
against any and all losses which may be incurred or suffered by any such applicants/drivers and
which may arise out of or result from:
(a) Breach of any warranties, obligations, covenants or declarations contained in this Agreement.
(b) Any third party claims made for loss or damage of whatever description caused to such or any
other third party as a result of the acts of applicants/drivers under this Agreement.
(c) All losses, cost, claims and expenses on account of any shortcoming including mistake, negligence
etc. on the part of the applicants in discharge of their various duties and responsibilities including
duties to take reasonable care and act prudently.
(d) Any and all actions, suits, proceedings, claim, judgments, cost, expenses, including incurred in
enforcing this indemnity under this agreement.
(e) Any other loss of life of applicant/driver during the selection process or driving any of the vehicles.

Further it is agreed and accepted that at all times during and after the term of this agreement, the
Applicants/Drivers and their legal heirs will indemnify or cause to be indemnified, defend and
hold harmless Volkswagen India Private Limited and its respective Directors, officers and
employees from and against any damage to vehicles caused by negligent driving or otherwise of
the applicants/drivers.

Insurance

The participants have taken note that there is no accident insurance to the applicant/driver. They
are also aware that in case of a liability claims among the applicants, drivers, vehicle keepers and
owners, the organisers’ or participants’ , they will keep VW India indemnified of such claims
whatsoever.

Where as the applicants/drivers are free to take there own accident insurance.

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 And the drivers/applicants shall keep VW India indemnified against personal injuries, death and
other claims of whatsoever nature made by Drivers/Applicants during and/or after the term of
this contract.

Disclaimer:

If the Volkswagen Polo Cup 2010 or the official season introductory course has to be called off
suddenly, the registered participants are correspondingly reimbursed with their fees.

If one or more events cannot take place for whatever reasons, the registered driver has no claim
whatsoever to reimbursement of accrued fees and/or other related expenses. In addition, assertion
of any claims for damages is disclaimed.

__________________ ________________________ ______________________

Place, Date Applicant’s signature Driver’s signature

______________________ __________________________
Applicant’s name in block letters Driver’s name in block letters

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