Telephone: __________________ Regulation 15(3) Sch. Form 9 substituted by S.R. No. 154/2013 reg. 12. 9 Form 9 Professional Boxing and Combat Sports Act 1985 DECLARATION I certify that I have sighted the results of the medical testing relating to [name of [address that the of contestant] of contestant] Board directed the contestant to undertake in Form 8 on [date] . The tests are dated: In relation to the results of the medical testing, the contestant is *FIT/UNFIT to compete in professional contests. Further testing is required. *YES/NO [If yes, please specify] CONFIRMATION OF IDENTITY I sighted a driver's licence or [insert as photographic proof other] of identity of [insert whose blood name of the professional contestant] test results I have reviewed. Medical Practitioner: Medical Practitioner's Signature: Qualifications: Address:
Telephone: __________________ Regulation 15(3) Sch. Form 9 substituted by S.R. No. 154/2013 reg. 12. 9 Form 9 Professional Boxing and Combat Sports Act 1985 DECLARATION I certify that I have sighted the results of the medical testing relating to [name of contestant] of [address of contestant] that the Board directed the contestant to undertake in Form 8 on [date] . The tests are dated: In relation to the results of the medical testing, the contestant is *FIT/UNFIT to compete in professional contests. Further testing is required. *YES/NO [If yes, please specify] CONFIRMATION OF IDENTITY I sighted a driver's licence or [insert other] as photographic proof of identity of [insert name of the professional contestant] whose blood test results I have reviewed. Medical Practitioner: Medical Practitioner's Signature: Qualifications: Address:
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