ANNEXURE A

[Regulation 2(1)]

To: Boxing SA

I hereby apply to be registered/for the renewal of my registration as a Promoter/Manager/Agent/Matchmaker/Trainer/Second/Boxer (delete where necessary) in terms of the regulations promulgated under section 34 of the South African Boxing Act, 2001 (Act No. 11 of 2001), and I agree to conform with and abide by all those regulations, with which I acknowledge myself to be fully acquainted.

I tender herewith R __________, being the prescribed registration/renewal fee payable.

The following particulars with regard to myself are true and correct, and I attach hereto documentary evidence of my identity:

Full name: ______________________________________________

Physical address: ________________________________________

Postal address: __________________________________________

_______________________________________________________

Date and place of birth: ____________________________________

Nationality: ______________________________________________

Country of origin: _________________________________________

Nude weight and height (boxers only): ________ kg ________ cm

Have you ever been convicted of any crime? (if so, give particulars):

_______________________________________________________

Have you ever been suspended as a licensee? __________________

Were you registered last year: _______________________________

If so:

In which Province? ________________________________________

In what capacity? _________________________________________

I have no knowledge of any material fact or circumstances which, if known, would induce Boxing SA to refuse to grant, or to grant under qualification, this application.

I accept that Boxing SA shall have the right to revoke my registration as a licensee should I fall to comply with the terms and conditions of the South African Boxing Act, 2001(Act No. 11 of 2001), or the Boxing Regulations, 2004, or bring Boxing SA into disrepute.

(Note: In the event of a juristic person applying to be registered as a Promoter, full written particulars of all its shareholders, members 'and directors must accompany this application.)

If a Manager, give names and addresses of boxers currently under your control:

If a Boxer, my medical examination shall include tests for the human immune-deficiency virus and hepatitis B and, additionally, in the case of a female boxer, a breast and pelvic examination.

If the applicant is an amateur boxer ho is currently registered with the South African Amateur Boxing Organisation (SANABO) and is preparing for a forthcoming Olympic Games, such an applicant must attach to his or her application to register as a professional boxer, written proof of his or her release from SANABO and/or the National Olympic Committee of South Africa (NOCSA) before his or her application can be considered by Boxing SA.

I hereby indemnify and hold Boxing SA harmless against any and all claims for damages howsoever caused or arising during my tenure as a licensee of Boxing SA whether such damages arise out of my activities in the boxing ring, at tournaments or when proceeding to or leaving venues of tournaments.

Date: _____________________________

Applicant __________________________