PSCB Application for Entry 2023

Starting No.
(To be completed by Series Organiser)

APPLICATION FOR Permanent Entry Guest Entry

(Tick one box only) Round 1 - Zandvoort
Event Name (Only for a Guest Entry)
992
Desired Starting No. (non-binding!) Class

COMPETITOR (to be completed by the team)

Team name
ASN Competitor Licence No.
Company
Managing Director (Frist name, Surname)
Street, No.
Postcode, City
Country VAT-number
Cell phone Email
TEAM MANAGER
Full name Email
Cell phone Date of birth
SECOND REPRESENTATIVE
Full name Email
Cell phone Date of birth

DRIVER 1
Full name ASN Driver Licence No.
Street, No.
Postcode, City Country
Cell phone Email
Nationality Date of birth

DRIVER 2 (if applicable)

Full name ASN Driver Licence No.
Street, No.
Postcode, City Country
Cell phone Email
Nationality Date of birth

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 PSCB Application for Entry 2023

Starting No.
(To be completed by Series Organiser)

VEHICLE DETAILS (to be completed by the vehicle Owner)

Manufacturer / Type Model Year
Car Identification No. Car Owner

If the Competitor is not the owner of the car for which the entry is claimed:
The owner(s) of the cars identified above must submit the waiver printed in Attachment 1. In case of false statements, the competitor shall release the persons
mentioned in the waiver from all claims of the car owner for damages that might occur in connection with the entire event(s). This also applies to the costs of the
car owner for bringing any appropriate legal action.

Full Season Entry Single Race Entry

In submitting the “Porsche Sprint Challenge Benelux Application for Entry” the
Competitor and Driver undertake and commits to participate in all 5
Competitions in the 2023 Porsche Sprint Challenge Benelux.
The deadline for the receipt of a “Porsche Sprint Challenge Benelux
Application for Entry” by the Series Organiser is 1st of May 2023. The Series
Organiser may, at his sole discretion, accept a “Porsche Sprint Challenge
Benelux Application for entry“ that is received after this date.
Full Season Entry Fee:
Payment before 15th March 2023 11.000 EUR ex VAT
Payment after 15th March 2023 11.500 EUR ex VAT
Included in the Full Season Entry Fee:
• Participation fee for 1 vehicle with 1/2 associated driver(s) during 5
PSCB race events
• 1 catering pass per race event
• Usage of pit garage (max 2 cars allocated per box)
A Competitor and Driver may apply for a Single Race Entry to participate only
for a single event of the 2023 Porsche Sprint Challenge Benelux.
In submitting the “Porsche Sprint Challenge Benelux Application for Entry” the
applicant acknowledges that the Single Race Driver is not eligible to score
points in any Classification.
Entries must be submitted to the Series Organiser at least 15 calendar days
prior to the start of the Competition concerned (ISC Art 2.1.7 refers). The
Series Organiser reserves the absolute right to accept or reject an application
for a Single Race Driver that arrives after this time limit.
Single Race Entry Fee:
Zandvoort, Assen, Zolder 2.450 EUR ex VAT
Spa 2.950 EUR ex VAT
Included in the Single Race Entry Fee:
• Participation fee for 1 vehicle with 1/2 associated driver(s) during one
PSCB race event
• 1 catering pass for one race event
• Usage of pit garage (max 2 cars allocated per box)

Monetary Transfer General Entry conditions

The correct amount payable should be transferred to the following bank In order to meet the deadlines for the receipt of an “Porsche Sprint Challenge
transfer details immediately upon application of entry. If the correct amount, Benelux Application for Entry” mentioned above, it is sufficient to send the
corresponding to the above tables, has been received, a confirmation and signed application without attachments by e-mail to
invoice will be sent to the entrant. Entry to the series is never complete without lars.plato@cupchallengebenelux.com in advance.
full payment. Please use the following details for your transfer. However, also the original paper version of the application has to be submitted
Recipient: Cup Challenge Benelux B.V. subsequently.
Reference: Team name/company, PSCB2023, Entry Fee
Bank: ING
IBAN: NL17INGB0634986449
BIC: INGBNL2A

The “Porsche Sprint Challenge Benelux Application for Entry” is completed
when the following conditions are fulfilled, and all documents are included
with the submission of the entry form:
• Fully completed “Porsche Sprint Challenge Benelux Application for En-
try“
• Copy of the valid 2023 ASN Driver licence (minimum national Grade C)
• Copy of the valid 2023 ASN Competitor licence
• Authorisation for the Driver to take part in International Competitions
abroad (ISC Art. 3.9.4 refers) (if applicable)
• Medical certificate of aptitude for the Driver (ISC Art 9.11 refers)
• Copy of the Driver’s identity card or passport
• Copy of the Competitor’s identity card or passport
• Payment of the Entry Fee
The Competitor and Driver are entitled to participate only when the “Porsche
Sprint Challenge Benelux Application for Entry” has been accepted and con-
firmed in writing by the Series Organiser. With this confirmation, the agree-
ment between the Series Organiser and the competitor is concluded.
Force majeure, labor disputes, civil disturbances, action by official bodies, and
other unforeseeable, unavoidable and serious occurrences, in particular re-
strictions and measures due to the Covid-19 pandemic, shall release the Se-
ries Organiser from his duties to perform regarding the aforementioned scope
of services. In case of cancellation of services, the Series Organiser will ac-
cordingly try to compensate the cancelled services with other services or re-
fund a reasonable part of the entry fee to the competitor.

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 PSCB Application for Entry 2023

Starting No.
(To be completed by Series Organiser)

General Contractual Declarations by the Competitor, Driver, Team Manager, car owner and other authorised representative

The Competitor, Driver, Team Manager, Car owner and other authorised representative declare that by signing and submitting the
“Porsche Sprint Challenge Benelux Application for Entry”, they confirm their complete understanding and adherence to all provi-
sions and legal notices of the Sporting and Technical Regulations of the Porsche Sprint Challenge Benelux 2023 as well as of the
present “Porsche Sprint Challenge Benelux Application for Entry” and its attachments. They further acknowledge they will act in
full compliance with the Sporting and Technical Regulations as mentioned above.

COMPETITOR

Name in capital letters Place, date Signature

TEAM MANAGER

Name in capital letters Place, date Signature

CAR OWNER

Name in capital letters Place, date Signature

DRIVER 1

Name in capital letters Place, date Signature

Signature by parent 1 Signature by parent 2

(*Driver < 18 years) (*Driver < 18 years)

DRIVER 2

Name in capital letters Place, date Signature

Signature by parent 1 Signature by parent 2

(*Driver < 18 years) (*Driver < 18 years)

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 PSCB Application for Entry 2023

Starting No.
(To be completed by Series Organiser)

Attachment 1
Car owner's waiver

Only required if the Competitor is not the owner of the car for which entry is claimed.

The car owner agrees to the participation of the described car in the “Porsche Sprint Challenge Benelux Application for Entry” in
the entire Porsche Sprint Challenge Benelux 2023 series and declares to renounce any claims for damages which may occur in
connection with the events, and specifically against
- The Series Organiser and its representatives, sponsors, and suppliers,
- The car owner’s own participants and helpers,
- The respective other participants, the owners and registered keepers of all cars participating in the event (as far as the
event takes place on a permanent or temporarily closed track) and respective helpers,
- FIA, KNAF, RACB, DMSB, the member organizations, their presidents, executive bodies, managing directors and general
secretaries,
- The promoter/Series Organiser, the Event Organiser, sporting stewards, circuit owners, the authorities, racing services,
and all other persons involved in the organization of the event,
- The road construction authorities and
- The various agents, legal representatives, full-time and honorary employees of all the persons and authorities mentioned
above
Except for injury to a person’s life, body or health or of any other damages caused knowingly and wilfully or through negligence by
the companies, institutions and other organizations listed above including their legal representatives or various agents, except for
statutory claims arising from the Netherlands Product Liability Act, and except for any other damages, caused knowingly and wil-
fully or through gross negligence by the companies, institutions and other organizations listed above including their legal repre-
sentatives or various agents.
This waiver covers all claims for any legal ground whatsoever including claims resulting from both, contractual and non-contractual
liability as well as unlawful acts.

Tacit exclusions of liability shall not be affected by the aforementioned non-liability clause.

Manufacturer / Type Model Year Car Identification No.

Car Owner Phone

Street, No. Postcode, City Country

Place, Date Signature / Stamp Car owner

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 PSCB Application for Entry 2023

Starting No.
(To be completed by Series Organiser)

Attachment 2
Emergency Information Driver 1

First name, surname Blood type Rhesus type

Medical conditions (if applicable)

Please notify in case of emergency:

First name, surname Phone number Relation to Driver

The emergency information will be kept confidential within the Porsche Sprint Challenge Benelux Organisation and will only be
used in case of emergency. It will not be shared with any other persons.

Emergency Information Driver 2

First name, surname Blood type Rhesus type

Medical conditions (if applicable)

Please notify in case of emergency:

First name, surname Phone number Relation to Driver

The emergency information will be kept confidential within the Porsche Sprint Challenge Benelux Organisation and will only be
used in case of emergency. It will not be shared with any other persons.

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 PSCB Application for Entry 2023

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Attachment 3.1
2023 Driver license Driver 1

First name, surname Licence number ASN

Frontside

Backside

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 PSCB Application for Entry 2023

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Attachment 3.2
2023 Driver license Driver 2

First name, surname Licence number ASN

Frontside

Backside

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 PSCB Application for Entry 2023

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Attachment 4
2023 Competitor license

Competitor Licence number ASN

Frontside

Backside

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Attachment 5
Legal Provisions
General contractual declarations by the Competitor and Driver
The Competitor and Driver declare that the statements made in the “Porsche
Sprint Challenge Benelux Application for Entry” are correct and complete and
that the Driver is in possession of a valid driver license for the car concerned and
fully able to comply with the demands of competition.
They further assure that the car is in full compliance with the technical
specifications of the various events and will be run only in technically and
optically perfect condition in the Porsche Sprint Challenge Benelux.
With their signatures they acknowledge:
• To have taken notice of the international FIA International Sporting Code
including all appendices, the legal and procedural KNAF rules, the PSCB 2023
Sporting & Technical Regulations, the KNAF circuit regulations, all other FIA and
KNAF provisions and the participation rules,
• To consider these regulations and provisions as binding and to strict-ly
observe them.
• That the sporting stewards at the respective events and the KNAF jurisdiction,
within the scope of their competencies, are entitled to fix penalties in case of
infringements.
• That the regulations and provisions as well as the declaration in this “Porsche
Sprint Challenge Benelux Application for Entry “ are an integral part of the entry
agreement concluded with the Series Organiser and the individ-ual Event
Organisers.
• To grant the Porsche Sprint Challenge Benelux and her partners the right to
use any photo- or video material or to actively use the presence of a Driver
and/or team during an event for marketing and promotional purposes.
The Competitor and Driver shall be held jointly and wholly responsible for any
claims and responsibilities resulting from the entry. The Competitor and Driver
shall accept consequences, either for or against themselves, caused by the
character or behavior of a team member (Competitor, Driver, mechan-ic,
assistant, guest, etc.), which relate to the agreement with the Series Organiser
or the individual Event Organisers, or which give reason for a damages claim or
which is in conflict with the concept or spirit of the Series and/or harmful to its
image. A possible such consequence could be exclu-sion from the Porsche
Sprint Challenge Benelux for the entrant and/or Driver(s) for a single event or
the remainder of the season, without the right to get any entry fee refunded.
Any such decision can be made arbitrarily by the Porsche Sprint Challenge
Benelux organization and cannot be appealed against.
Non-liability declarations by the Competitor and Driver
The Competitor and Driver attend the entire event at their own risk, their
connected third parties and their goods may risk damage, injury, and com-
mercial loss including resultant loss. They bear the undivided responsibility,
both civil and criminal, for any damages caused either by themselves or by the
car used by them in all cases so long as no liability waiver has been agreed upon
with this ‘Porsche Sprint Challenge Benelux Application for Entry’ document.
By filling and signing the ‘Porsche Sprint Challenge Benelux Application for
Entry’ document, the Competitor and Driver agree, within the scope of the
events, to waive any claims for liabilities and/or damages of any kind against:
• Porsche AG and its representatives, sponsors and suppliers,
• The Series Organiser and its parent company Cup Challenge Benelux B.V. and
its shareholders,
• its representatives, sponsors, and suppliers,
• The competitor’s and driver’s own participants and helpers,
• The respective other participants, the owners and registered keepers of all
cars participating in the event (as far as the event takes place on a permanent or
temporarily closed track) and respective helpers,
• FIA, KNAF, RACB, DMSB, the member organizations of the KNAF, their
presidents, executive bodies, managing directors and general secre-taries,
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PSCB Application for Entry 2023
Starting No.
(To be completed by Series Organiser)
• The promoter/Series Organiser,
• D’Ieteren Porsche Import, Pon Porsche Import, and their legal repre-
sentatives,
• Organizers of the events, sporting stewards and officials, circuit owners, the
authorities, racing services, and all other persons involved in the organization of
the event,
• The authorities, racing services, and all other persons involved in the
organization of the events,
• The road construction authorities, in so far as damages are due to the
condition of the roads and road equipment used for the event.
• the various agents, legal representatives, full-time and honorary employees of
all the persons and authorities mentioned above,
with the following exceptions:
• This waiver does not apply if the companies, institutions, and other
organizations listed above including their legal representatives or vari-ous
agents (hereinafter jointly referred to as the “Beneficiaries”) act grossly
negligent (grob fahrlässig) or intentional (vorsätzlich) or in the event of injury to
life, limb or health.
• Likewise, it does not apply in the event of a violation of material con-tractual
obligations, namely obligations whose fulfillment makes the proper realization
of the event possible and the competitor regularly re-lies on and may rely on.
However, in such cases, the liability of the Beneficiaries is limited to the
compensation of the foreseeable, typi-cally occurring damage.
• Likewise, it does not apply if the Beneficiaries act fraudulently or assume a
guarantee or a procurement risk. The waiver has also no ef-fect on any
mandatory statutory liability, including without limitation under the German
Product liability act (Produkthaftungsgesetz).
This waiver shall take effect with the filing of this “‘Porsche Sprint Challenge
Benelux Application for Entry”. It applies to all claims for any legal reason
whatsoever including claims resulting from both contractual and non-
contractual liability as well as unlawful acts.
Tacit exclusions of liability shall not be affected by the aforementioned non-
liability clause.
By signing the “Porsche Sprint Challenge Benelux Application for Entry” for the
Porsche Sprint Challenge Benelux 2023, the Competitor and Driver
acknowledge and accept the exclusion of liability.
Upon submitting the “Porsche Sprint Challenge Benelux Application for Entry”,
the Com-petitor and Driver acknowledge that no insurance coverage for motor
traffic (car insurance, comprehensive insurance, and motor passenger personal
accidence insurance) is provided for damages within a race event, aiming to
achieve top speeds. The Competitor is obliged to inform the vehicle keeper and
owner of the entered race cars thereof.
In case of occurring damage or determined injury respectively in the case of
damages to health which may question the motor sportive fitness on a
continuing basis or temporarily, the Competitor and Driver release all treat-ing
physicians – considering the resulting safety risk not only for him-self/herself
but also for third parties – from the medical confidentiality among each other as
well as towards the race director, leading physician, sporting stewards, medical
director of operations, KNAF organisation medi-cal, coordination office
automotive sports and the insurance damages office.
With their signatures, the Competitor and Driver agree to personal data being
stored, transferred, and processed according to the data privacy regulations of
the KNAF, under consideration of the federal data privacy act. At any time, they
have the right to obtain information on these data from the KNAF data
protection officer and/or to practice their right of objection.
The data protection laws can be viewed at www.KNAF.nl at any time and/or can
be requested from the Series Organiser on site.
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 PSCB Application for Entry 2023

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The rules of participation are defined and published by the Event Organisers. • in print media (in particular brochures, catalogs, company presenta-tions and
The Series Organiser cannot be held responsible for Competitors or Drivers not information, newsletters, printed works and/or compendi-ums),
adhering to the rules established by the Event Organisers. The Series Organiser • in the form of commercials and trailers or editorial contributions (such as in TV
is also not responsible for any refusal by an individual Event Organiser in or radio broadcasts or the cinema), on video or audio record-ings of all types (in
allowing a Competitor or Driver to enter or participate in an event. particular CDs, DVDs, Blu-ray, USB sticks) on all other data carriers and on
databases and
Insurance • in one of the aforementioned forms at festivals, trade fairs, and other events.
With this “Porsche Sprint Challenge Benelux Application for Entry” the • Included in particular is the right to use, distribute, utilize, perform in public,
competitor and driver commits himself to take out sufficient insurance for broadcast, reproduce, archive, and make available for public access the
himself, his racing team and any other third party commissioned by himself Recordings.
against any damages relating to his partici-pation in the Porsche Sprint 3.The competitor further agrees that the Recordings may be modified, altered,
Challenge Benelux 2023. Neither the Event Organiser nor the Series Organiser cut, or used and utilized together with other content such as pictures, video,
will take out any insurance of this kind. If claims for damages relating to or audio and text elements, and graphics as described under 1. and 2.
caused by the competitor are made against the Series Organiser or any third 4.The competitor guarantees that it has the rights and consents required for
party working on behalf of the Series Organiser, the competitor shall release the this consent and waiver declaration. This includes, in particular, the consent of
Series Organiser or any third parties working on behalf of the Series Organiser team members to use the Recordings as described under 1. and 2. The
from any such liability claims. competitor will obtain the corresponding declarations of consent from team
members and produce these when requested to do so by the Series Organis-er.
Guidelines for the use of Film and Picture Material The competitor waives the right to check and approve of the use of the
The Series Organiser is the owner of all picture/live-rights of all material that is Recordings. The competitor acknowledges and confirms that it is not entitled to
produced for PSCB for all media (internet, live-stream, social media platforms, remuneration with regard to the filming and use of the Recordings.
TV, and others). The Series Organiser has installed several free-of-charge media
databases to provide the competitors with extensive film and picture material. Privacy statement
The Series Organiser must ensure to safeguard copy-right, exclusive TV rights Cup Challenge B.V. converts and uses the personal data indicated in this
holders, and integrity. Therefore, the consent to the use of the provided document exclusively for the organization and execution of the Porsche Sprint
materials from the various databases is only granted while the competitor is Challenge Benelux. Personal data will not be passed on to third parties, except
competing in PSCB for the purpose of showcasing the PSCB to (prospective) for series’
sponsors and drivers and under the express reservation that the competitor partners and only in case such a thing is relevant for an entrant's participa-tion
must ensure at all times and without excep-tion that no content shall in the series.
• bring the Series Organiser or any person and/or organization associat-ed
therewith in to disrepute, Choice of law and legal venue
• be published that is considered confidential or not public, This “Porsche Sprint Challenge Benelux Application for Entry", any agreement
• contain any material that is defamatory, offensive discriminatory, or resulting from it and their interpretation are governed by the laws of The
blasphemous, Netherlands, excluding the application of the United Nations Convention on
• violate any law or the terms of any platform on which it is placed. Contracts for the International Sale of Goods (CISG). The place of jurisdiction
If in doubt, the competitor is obliged to contact the Series Organiser before shall be The Netherlands unless the jurisdiction of the FIA, the KNAF, the
using any of the material. Stewards, the Series Organiser as a judge in terms of The Netherlands Civil
Code or their respective courts is given.
Consent and Waiver Declaration for the use of Film and Picture Material
1.The competitor hereby agrees that the Series Organiser and the service
providers commissioned by it may make movies, photos, stills, other audio and
audio-visual recordings and pictures ("Recordings") or have them made of the
racetrack, paddock, pit lane, or any other facilities belonging to the
infrastructure of the competitor, both from within and without, within the
framework of PSCB. The competitor permits the Series Organiser and its service
providers access to the above-mentioned facilities for this purpose. The
competitor hereby also agrees that drivers, engineers, and other team members
or guests ("Team Members") may be filmed within the context of making these
Recordings. The approval of the competitor covers the use of the Recordings for
all advertising, editorial, and/or publishing purposes of the SeriesOrganiser.
2.The Series Organiser and its licensees, authorized representatives, part-ners,
and legal successors are entitled based on this consent to use the Recordings
and the likeness, form, image, and voice of Team Members in the context of the
Recordings, without restriction as to location and time and in any manner
whatsoever and connection with any currently available media or media
available in the future and also in the form of utilization not yet known. This
covers, in particular, the use and utilization of the Recordings
• in radio and television broadcasting in any technical form irrespective of the
means of transmission (terrestrial, cable, or satellite), including live streaming
and IP TV
• in digital form and on online media (in particular on the Internet on the
company webpage or social media channels of the Series Organiser and their
licensees, authorized representatives, partners, and legal successors),

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