APPLICATION
For a FIBA Players' Agent’s Licence
Test in Miami, Florida, USA
Thursday 23rd October 2014
In accordance with the FIBA
Internal Regulation governing Players Agents
I. Personal Data
Agency/Company
_____________________________________________________________
Family (last) Name
_____________________________________________________________
First (given) Name
_____________________________________________________________
Company Address
Street ________________________________________________________
Private Address
_______________________________________________________
Zip Code ______________ City _________________________________
Country _____________________________________________________
Telephone:
Country code________City code_________Number___________________
Mobile phone:
Country code________City code_________Number___________________
Fax:
Country code________City code_________Number___________________
E-mail:
other than “@ aol.com”
aol.com : _______________________________________
Date of Birth:
Day_________________Month_____________Year___________________
Place of Birth:
_____________________________________________________________
Nationality:
_____________________________________________________________
II. The Following Documents are attached to this Application
A copy of your passport
A passport-size picture (for the website & the licence card)
A Certificate of No Conviction or Letter of Good Standing or Criminal Record Check issued by
your local FBI office or National Government Authorities and not older than 6 months
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III. Declarations
I hereby declare that I do not hold a position with FIBA, a Zone Commission, a National Federation, a
Club or any Organisation connected with such entities such as leagues or Players Associations. I also
declare that I hold no position with any other international or national basketball organisation in
accordance with Article 33-142.
142.
I recognise that I will be invited by FIBA for a personal interview and a test and that I will have to pay a
fee of US $ 200. - for the test.
Except in case of a Test exemption – NBPA /WNBPA or BAR members
I recognise that I will have to pay an annual fee in accordance with Article 33-154 of the FIBA Agent
Regulation as long as I hold a FIBA Players' Agent Licence.
I intend to participate in the personal interview and the next test in The USA on Thursday 23rd
October 2014 at the EPIC Hotel – 270 Key Biscane Blvd. Way – Miami,
Miami, FL 33131
(www.epichotel.com/downtownwww.epichotel.com/downtown-miamimiami-hotel/accommodations.html)
hotel/accommodations.html)
I recognise that in accordance with Article 33-153 of the FIBA Agent Regulation I will have to attend all
refresher seminars organised by FIBA to verify that the requirements for the issuing of the licence are
still met.
I recognise that the FIBA Internal Regulations, in particular the FIBA Agents Regulation as amended
from time to time are applicable to my relationship with FIBA as a Players' Agent and I further
recognise that I am subject to disciplinary sanctions by FIBA in case of breach of any of these
regulations.
I recognise that in accordance with Article 33-151 of the FIBA Agent Regulation in the event that the
national federation of my home country enacts regulations governing the activities of agents, I will be
obliged to prove to FIBA that I am the holder of a valid licence issued by that federation.
Date: ______________________________
Place: ______________________________
Signature: _____________________________
once completed please send the form with all attachments to Francine : [email protected]
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