INDONESIA 2012 WORLD STAMP CHAMPIONSHIP AND EXHIBITION Philatelic Literature Exhibit Information Form

Author(s) Exhibitor(s) [(if differs from Author(s)] Title of exhibit

: : : :

Publisher / where to order Year of publishing (of current edition) Which edition (1st, 2nd or 3rd etc) Number of pages Format (..mm x ..mm) Frequency of publication (periodicals only) Price ISBN Quantity Printed Brief description (up to 50 words)

: :

: : :

: : :

Contents (to attach a copy of contents page, Preferably in English, in addition to the published language) Additional information: such as Preface, introductory page etc would be useful

INDONESIA 2012 WORLD STAMP CHAMPIONSHIP AND EXHIBITION Exhibit Application Form

June 18 to 24, 2012

Fill in a separate form for each exhibit. Please print or type in block letters This Exhibit Application Form must be returned through the Commissioners to reach the Commissioner General by September 30, 2011 at the address below: INDONESIA 2012 World Stamp Championship Exhibition Jl. Pos No. 2, Jakarta 10710, Indonesia Phone: +62.21.3518711, Fax: +62.21.35186710 filatelis_indonesia@yahoo.com

First Time Entry Mr Pseudonym Address Mrs

: Yes Miss

No Tel Surname Date of birth (for youth class only) Fax First Name Telephone Email Fax Email

FIP IDENTITY NUMBER :

Title of this exhibit (in English)

Previous title

Short description of the exhibit (in English)

1) Introduction page included

Yes

No

2) Philatelic Literature Exhibit Information Form included (only applicable for Literature exhibits in Class 11) Exhibit class Number of frames applied for Dimensions of sheets (in cm) B The exhibit will be delivered International (FIAP/FEPA) / By Commissioner By self (The exhibitor) By Air cargo (Please specify) World (FIP) Exhibitions PAST AWARDS RECEIVED LG G LV V LS A

Yes

No

A= B = S SB B

National Exhibitions

The undersigned (Exhibitor) hereby (1) agrees to accept all FIP Regulations (GREX, GREV, SREVS) and the individual regulations (IREX) applying to INDONESIA 2012 (2) confirms that the exhibit is owned by me (GREX Article 11.2)

Date Commissioners declaration Remarks

Signature

Date Exhibition Venue:

White (2) - INDONESIA 2012 Blue (1) - Commissioner

Signature

Yellow (1) - Exhibitor

White (2) - INDONESIA 2012

Yellow (1) - Commissioner

Blue (1) - Exhibitor

INDONESIA 2012 WORLD STAMP CHAMPIONSHIP AND EXHIBITION

Inventory of the Exhibit

Exhibitors Name Exhibitors Address Title of Exhibit
No. of Frames
Page No. Stamps Stationery
Cover

Postal Code :

Group
Other Items Page No. Stamps Stationery
Cover

Class
Other Items Page No. Stamps Stationery
Cover

Other Items

Page No.

Cover Other Stamps Stationery Items

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
For official use only

97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128

Signature of Exhibitor Date

Entry

Exit

White (2) - INDONESIA 2012

Yellow (1) - Commissioner

Blue (1) - Exhibitor