UCI CYCLING REGULATIONS  6a. UCI ID (current and past holders of UCI ID): 6b. UCI ID required (not yet holder of UCI ID but necessary for following season): yes/no  7. Place and address of main residence at the time of application:  8. Place and country of the previous main residence if changed in the last year:  9. Countries in which the applicant has other residences:  10.  Contact person: Phone number of the contact person$^{1}$:  11. Authority (federation or UCI) that issued the applicant's previous licence:  12. Authority (federation or UCI) that has refused to issue a licence during the past  three years:  13. Applicant's club:  14. Applicant's UCI team (name and type):  15. If the applicant is currently suspended and will continue to be for all or part of the  year of validity of the licence, the name of the authority that imposed the  suspension and the starting and ending dates of the suspension:  16. Insurance for bodily injury (in and out-patient hospital expenses and medical  care, transport costs, permanent disablement, death) and material damages (loss  of earnings) in case of accident on the occasion of a cycling competition or event  or during training:  -  name and address of the insurance company:  -  name and address of the insured party:  -  duration of validity of the insurance policy,  -  amount of cover guaranteed  -  territorial validity.  17. Third-party liability insurance for material damage or bodily injury caused to  others in the course of a competition or cycling event or during training:  -  name and address of the insurance company:  -  name and address of the insured party:  -  duration of validity of the insurance policy,  -  amount of cover guaranteed  -  territorial validity.  (text modified on 15.10.04; 01.01.17; 01.01.18; 01.10.18)  1.1.023 1. I hereby declare that I am aware of no reason why I should not be granted the  requested licence.  Back (Part II) I undertake to spontaneously return my licence in the event of any substantial change to  the circumstances existing at the time of the application for a licence.  I declare that I have not applied for a licence for the same year to the UCI or to any other  national federation.  I assume exclusive liability for this application and for the use that I shall make of the  licence. 1 I take note that it is strongly recommended to enter a contact person who may be contacted in  case of an emergency or an incident involving me during my participation in an event. In this  regard, I confirm that the contact person indicated on the form has consented to his identity and  contact details being mentioned on my licence. E0221  GENERAL ORGANISATION OF CYCLING AS A SPORT  8 