Entry form Prijavnica

Prijavnica RNG

ENTRY FORM

INSCRIPTION ENTRY FORM / PRIJAVNICA

MAHLE 8. Eco Rally

10. - 12. April 2025, Nova Gorica, Slovenia

2025 Bridgestone FIA ecoRally Cup

Avto moto društvo Gorica

Cesta IX. Korpusa 48, 5250 Solkan, Slovenia

APPLICATION TO REGISTER

APPLICATION TO REGISTER / VLOGA ZA REGISTRACIJO

# Filled by the Organizer / Izpolni organizator

Date and time received / Datum in ura prejetja:

Time/Ura

Entry no. /Št. vnosa:

Rally no. / Štartna št. :

COMPETITOR / TEKMOVALEC

COMPETITOR / TEKMOVALEC

Name/Ime:

Licence no./Št. Licence:

DRIVER/VOZNIK

DRIVER/VOZNIK

Name/Ime

First surname/Priimek

Address/Naslov

Num./Hišna št.

Town or city / Kraj

Postal code/Poštna številka

Licence no./Št. Licence

ID number/Št. Os. dokumenta

Nationality/Nacionalnost

Mobile phone/Mobilna št.

E-mail/Elektronski naslov

CO-DRIVER/SOVOZNIK

CO-DRIVER/SOVOZNIK

Name/Ime

First surname/Priimek

Address/Naslov

Number/Hišna št.

Town or city/Kraj

Postal code/Poštna številka

Licence no./Št. Licence

ID number/Št. os. dokumenta

Nationality/Nacionalnost

Mobile phone/Mobilna št.

E-mail/Elektronski naslov

VEHICLE/VOZILO

VEHICLE/VOZILO

Manufacturer/Proizvajalec

Model

Year & month of construction /Leto & mesec proizvodnje

Predominant colour/Prevladujoča barva

Registration number/Registracijska oznaka

Chassis no./Št. Šasije

Country of registration/Država registracije

Weight / Teža

CATEGORY/KATEGORIJA

CATEGORY/KATEGORIJA

Option

EV :

Standard full electric model/Standardno električno vozilo:

FCEV :

Fuel Hydrogen/ Vozilo na Vodik

Proof of payment

Application to Register/Vloga za registracijo

Proof of payment of registration fees issued by bank/Potrdilo o plačilu pristojbine

1 Passport

Driver/Voznik

1 Passport-sized photo/1x slika kot v potnem listu

Upload a

Upload Prenos

Driver’s Driving License

Photocopy of Driver’s Driving License/Fotokopija vozniškega dovoljenja

Driving licence Side A

Upload Prenos

Driving licence Side B

Upload Prenos

National Identity

Photocopy of National Identity/Fotokopija potrdila o nacionalnosti

National Identity

Upload Prenos

1 Passport

Co-driver

1 Passport-sized photo/1x slika kot v potnem listu

Co driver license

Upload Prenos

Co-Driver’s Driving License

Photocopy of Co-Driver’s Driving License/Fotokopija vozniškega dovoljenja

Co-driver license side A

Upload Prenos

Co-driver licence Side B

Upload Prenos

National Identity

Photocopy of National Identity/Fotokopija potrdila o nacionalnosti

Co-driver National Identity

Upload Prenos

REGISTRATION FEES/PRISTOJBINA ZA PRIJAVO

REGISTRATION FEES/PRISTOJBINA ZA PRIJAVO

Amount-Znesek

Amount Znesek

WITH Organiser’s

WITH Organiser’s publicity/Z reklamo organizatorja

600€ with add

600€

600€

WITHOUT Organizer’s

WITHOUT Organizer’s publicity/Brez reklam organizatorja

1200€ no add

1200€

1200€

PERMISSION TO PARTICIPATE/DOVOLJENJE ZA UDELEŽBO

PERMISSION TO PARTICIPATE/DOVOLJENJE ZA UDELEŽBO

without licence

Permission to participate for participants without licence / Dovoljenje za udeležbo prijavljenih brez licence:

Driver/Voznik

Co-driver/Sovoznik

free VAT

AMOUNT PERMITS FOR PARTECIPATION – Exempt from VAT

VREDNOST ZA DOVOLJENJE ZA UDELEŽBO – brez davka

€

Details of bank

Details of bank account into which the total amount has to be paid:

Podatki o bančnem računu na katerega se vplača skupni znesek:

Avto moto društvo Gorica

Nova KBM : SI56 0400 1004 6912 972

BILLING INFORMATION

BILLING INFORMATION/INFORMACIJE O PLAČILU

Name/Ime

New Field

Address/Naslov

Num./Hišna št.

Town or city/Kraj

Postal code/Poštna št.

Country/Država

I accept/ Se Strinjam

The undersigned accepts responsibility for the details that figure in this document, and declares and he or she is familiar with and accepts the rules governing the event, and requests to be registered. / Spodaj podpisani sprejemam odgovornost za pravilnost podatkov in izjavljam da sta on/ona seznanjena z in sprejemata pravila, ki ureja dogodek in zahteve za registracijo

Date/Datum