Clone of ABBIGLIAMENTO DI SICUREZZA ITA

mod. CAS3
Spett.le Automobile Club d'Italia
Federazione Sportiva Nazionale Automobilistica
via Solferino 32 00185- Roma
DECLARATION OF SAFETY CLOTHING CONFORMITY
This form is valid for one year. Print it out and bring it with you to every Italian Cross Country race.

(It should only be recompiled in the event of a change of clothing.)
DRIVER / NAVIGATOR

Print this form and bring/send it to each competition.
The undersigned Driver / Navigator*

NameSurname
date of birth*

DayMonthYear
Date
place of birth*
identity document*
number*
Expires on*

DayMonthYear
Date
Upload File*

Copy of identity document
Cancelof
license no.*
Entered in the Event/Championship:*
aware of sporting sanctions
DECLARES
under his own responsibility,
- to be aware of the safety clothes regulations (Appendix L to the FIA Sporting Code);
- that all components of the safety clothing used comply with the standards in force;
- undertakes to use only the safety clothing indicated in this declaration.
- Only for Drivers/Navigators entered in a Championship, this certification will be valid for the entire duration of the Championship and only for the races included in it. Furthermore, those who sign it undertake to promptly communicate any changes that may occur during the Championship itself.

1. HELMET *

2. FRONTAL HEAD RESTRAINT SYSTEM*

3. OVERALL*

4. TOP UNDERWEAR*

5. BOTTOM UNDERWEAR*

6. BALACLAVA*

7. SOCKS*

8. SHOES*

9. GLOVES

(*) Use the columns if the same conductor will be using different devices during the event.
He/she also declares to be informed, having given his/her consent at the time of sports affiliation, that the personal data collected will be processed, also by IT tools, in the context of the procedure for which this declaration is made.
(place of signature)
Date

GiornoMeseAnno
Date
Firma*

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DECLARATION OF SAFETY CLOTHING CONFORMITY