טופס מייצג – אנגלית להורדה, הדפסה ומילוי מקוון

Form Title: Declaration of Intermediary for Youth Football Leagues

Summary:
This form is titled "Declaration of Intermediary" and is intended for individuals or corporate bodies acting as intermediaries in the field of youth football leagues. It requires the intermediary to provide personal and contact information and make several declarations regarding their activities in accordance with the law and regulations of the Israel Football Association and FIFA.

Required Information:
1. First name/s and Surname/s of the intermediary.
2. I.D. No./s.
3. Date of birth.
4. Citizenship / citizenships.
5. Full permanent address, including telephone and facsimile numbers, and an email address.
6. If the intermediary is a body corporate, it requires the name, type, registration number, and address of the body corporate.

Declarations Made by the Intermediary:
1. The intermediary declares their commitment to comply with all relevant laws, especially those related to labor relationships in their capacity as an intermediary. They also agree to abide by the bylaws of the Association and FIFA's rules regarding their activities.
2. The intermediary confirms that they do not hold or have held any positions or offices within the Israel Football Association, other football associations, or football teams in Israel or abroad for the 12 months preceding the date of signing this declaration and for the 12 months following any approved transaction.
3. The intermediary states that they have never been convicted of a criminal offense related to violence or financial matters.
4. The intermediary declares that they have no contractual relationships that may create a conflict of interest with the League Administration, associations, confederations, or FIFA. Any such relationships must be disclosed.
5. The intermediary confirms that they will not receive any payments related to player transfers, future transfers, training, solidarity payments, or any other payments connected to player transactions. Such payments will also not be considered when calculating the agent's fee.
6. The intermediary commits not to accept payments if the player involved is a minor.
7. The intermediary pledges not to participate in illegal gambling or legal gambling related to matches of the player or team they represent, except for "Toto 16" wagers.
8. The intermediary consents to the Association receiving full details of any payments received from clubs or players for their services as an agent.
9. The intermediary agrees to transfer all contracts, agreements, and records related to their activities as an agent to the Association.
10. The intermediary allows the Association to publish the details mentioned in the agreements, including on its website.
11. The intermediary consents to the publication of any disciplinary penalties or measures imposed on them by the Association, with reporting to FIFA.
12. The intermediary acknowledges that this declaration will be available to authorized bodies of the Association.
13. The intermediary can provide additional relevant details as necessary.

The declaration must be made in good faith and based on the information available at the time of signing. The intermediary agrees to notify the Association of any changes in the provided information. The form requires the intermediary's signature and includes space for the date and place of signing.