Declaration for Importation of Medical EquipmentFor Dubai 2019 World Para Athletics Championships

984026 Name of Country984026 Name of Team Leader 984026 Name of Chief Physician 984026 Address 984026 Phone 984026 Fax 984026 E-mail

Name of Product(Product Category) Unit Quantit

y TypeModel Manufacturer Made in Purpose(Main Purpose)

I hereby declare the above medical equipment for our team to be imported for the Dubai 2019 World Para

Athletics Championship

Dateddmmyyyy Chief Physician Name Signature

Note The details must be filled in either Arabic or English on this given form If more space is needed please feel free to use additional forms accordingly Caution The Form must be submit by 1st Oct 2019 and the medical equipment must be re-exported out from Dubai directly after the completion of the championship Submit to

World Para Athletics Championship-Dubai 2019 Tel +971 4 2988205Address AlQusais1 Behind Stadium Metro Station Fax +971 4 298 8459PO Box 20990 Dubai UAE Email medicaldxb2019dcdorgae