Rider's Agent/Rider Authorisation

This is an ELECTRONIC APPLICATION. Printing the form and filling it out by hand will make your application ineligible.

This Authorisation Form identifies the name(s) of the Rider(s) whom you wish to act as agent for. You will need to have the Rider sign this form. In the case of an Apprentice Jockey, this form must also be signed by their employer (who will be responsible for paying your fees from their percentage of the Apprentice Jockey’s earnings).

PLEASE NOTE: All fields marked with (*) must be completed and the attachments below must be submitted with your application. Your application will not be considered until it is complete, and all necessary attachments have been received.

Name*

First NameLast Name

Email*

example@example.com

Licence ID Number

Signature

Rider Type*

JockeyApprentice Jockey

Name*

First NameLast Name

Rider Email

example@example.com

Licence ID Number

Signature

Apprentice Employer Licence ID Number

Apprentice Employer Email

example@example.com

Employer Signature

This information is being collected, and will be held, by New Zealand Thoroughbred Racing (NZTR), 18 Dick Street, Cambridge. It is being collected for the purpose of processing the application made under this form and for performing NZTR’s functions under the Racing Industry Act 2020 and the Rules of Racing (including relating to licensing and registration, as applicable). You agree that the personal information supplied by you may be retained and used by NZTR and by third parties (if applicable) for these purposes and any directly related purposes. You also agree (unless you tick the box below or notify us otherwise), that NZTR may use this information for direct marketing or providing you with information on events, products and services, and that it may be disclosed by NZTR to, and used by, third parties for these purposes.

NZTR will not use or disclose your personal information in any way, other than that disclosed in this policy or with your prior consent. If you do not provide the requested information, then NZTR may not be able to process your application under this form.

If you do not wish your information to be used by NZTR, or to be disclosed by it to third parties, for the purpose of direct marketing and providing you with information on events, products and services, then please tick the box below. Otherwise, you may at any time opt out of your information being used or disclosed by NZTR in this way by notifying NZTR to that effect by email (office@nztr.co.nz) or by letter to the address set out above.

I understand the Privacy Act requirements*

Yes

Acknowledge below if you do not wish your information to be disclosed by NZTR

I do not agree to my personal information being used by NZTR, or being disclosed by it to third parties for use, for direct marketing or providing me with information on events, products and services

CONTACT US

If you have any queries relating to this application, please contact NZTR Licensing at:

tel: +64 27 4207 4734

email: licensing@nztr.co.nz

Riders Agent/Rider Authorisation

Riders Agent

Rider/Apprentice Rider

Privacy Act