SELF-SCRUTINEERING FORM

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1. Give the following undertaking as required in terms of GCR 93 (iii) namely: "I declare that any vehicle/machine entered by me, will comply with all regulations and specifications pertaining to the event entered/category of motorsport concerned. I accept, subject to my rights of protest and appeal, which action will be taken against me as the entrant and/or driver and/or rider, in accordance with the provisions of MSA’s regulations, if my vehicle/machine is found not to comply with the relevant regulations and specifications.” 2. Confirm that all safety requirements relating to both the vehicle/machine and those referring to the personal protective equipment and apparel of the rider, are fully compliant with the regulations, have not reached their expiry date (where applicable), and have been correctly installed. 3. The vehicle/machine has been inspected by us and is in all respects in a proper and safe condition and is fully compliant with all applicable legislation relating to vehicles used on public roads (where applicable). 4. Indemnify, and hold harmless, Motorsport South Africa, the promoters, organisers, all officials, landowners and other persons associated with the event from all consequences which may arise from any failure on our part to diligently undertake the self-scrutiny process required in terms of MSA’s regulations and/or any supplementary official circulars.