טופס הצהרת מייצג – אנגלית להורדה, הדפסה ומילוי מקוון

Form Name: Intermediary Declaration for Amateur Football Leagues

Purpose of the Form: This form, titled "Intermediary Declaration," is used in the context of amateur football leagues and pertains to individuals or organizations acting as intermediaries in football-related transactions. It outlines various declarations and commitments that intermediaries must adhere to in their activities. These commitments are designed to ensure the integrity and legality of their actions within the football community.

Sections Requiring Completion:
1. Personal Information:
- First name/s
- Surname/s
- I.D. No./s
- Date of birth
- Citizenship / citizenships
- Full permanent address (including contact details)

2. Information for Body Corporate (if applicable):
- Name of the body corporate
- Type of body corporate
- Registration number of the body corporate
- Address of the body corporate

Declarations and Commitments:
The intermediary, whether an individual or a body corporate, must declare and agree to the following:

1. To comply with all relevant laws, including those related to representation and labor relationships, and to be bound by the bylaws of the Association and FIFA rules in connection with their activities as an agent.

2. Not to hold any position or office within football associations, football teams, or related entities for 12 months before or after the transaction they are involved in.

3. Not to have a criminal record related to violence or financial matters.

4. Not to have any contractual relationships that could result in a conflict of interest, and to disclose any such relationships to the Association.

5. Not to receive payments related to player transfers, training, solidarity payments, or other financial aspects of football transactions, except for the agent's fee.

6. Not to accept payments when representing minor players.

7. Not to engage in illegal gambling and to limit participation in legal gambling to "Toto 16" framework.

8. To grant consent for the Association to receive information about payments for their services from clubs or players.

9. To transfer all contracts, agreements, and records related to their activities as an agent to the Association.

10. Agree that the Association will retain and publish information related to their agreements, including on its website.

11. Allow the Association to publish details of any disciplinary penalties or measures taken against them and report them to FIFA.

12. Acknowledge that this declaration will be available to authorized bodies of the Association.

13. Provide any additional relevant details they believe should be included.

The declaration must be made in good faith, based on the information available at the time of submission. The intermediary must also agree to notify the Association promptly if any of the provided information changes.

The form should be signed and dated by the intermediary.

Please note that this summary does not include the detailed contact information and the extensive declaration text, as requested.