CLUB NAME:

Date of Grading

Examiner Name:

I am submitting a total number of candidates for certification: I am submitting a total number of candidates for certification:123456789101112131415161718192021222324252627282930

NOTE: NOTE: 1. If there is insufficient room on this form for your total number of candidates please submit a second form. 2. Should you have another grading date you wish to request certificates for you need to submit your candidates on a separate form. 3. It is your responsibility to ensure you have accurately created the profile for your candidate in the ITF online system AND uploaded a photo. This must be completed PRIOR to submitting this form. 4. You will be invoiced by ANTAA at the time of processing.

CANDIDATE 1 CANDIDATE 1 CANDIDATE 1

First Name

Last Name

Requested rank

CANDIDATE 2 CANDIDATE 2 CANDIDATE 2

First Name

Last Name

Requested rank

CANDIDATE 3 CANDIDATE 3 CANDIDATE 3

First Name

Last Name

Requested rank

CANDIDATE 4 CANDIDATE 4 CANDIDATE 4

First Name

Last Name

Requested rank

CANDIDATE 5 CANDIDATE 5 CANDIDATE 5

First Name

Last Name

Requested rank

CANDIDATE 6 CANDIDATE 6 CANDIDATE 6

Requested rank

Last Name

First Name