Name (First name, surname). Date of Birth. Identification (copy passport or national ID document). Discipline(s). Describe the Applicant's current coach(es) and all contacts the Applicant has or has had with officials, coaches, doctors, support persons an

Name (First name, surname)

Sex

Date of Birth

Identification (copy passport or national ID document)

Discipline(s)

Describe the Applicant's current coach(es) and all contacts the Applicant has or has had with officials, coaches, doctors, support persons and other appointees of RusAF (and/or previously ARAF) and the period over which such contacts have existed

(State in each case the name and nature of the contact as well as period of contact e. g. Mr XYZ, Coach, since 2010)

Was the Applicant in a national or international Registered Testing Pool in 2020and in 2021 to date and, if so, which one(s), since when and to whom did the Applicant send his/her whereabouts information during the relevant period?

How many samples (urine, blood and/or Athlete Biological Passport samples) have been collected from the Applicant during the period since he/she was in a Registered Testing Pool (as described in 7 above)?

Were there any times during 2020 or 2021 to date when the Applicant has not been subject to testing by World Athletics, RUSADA or other WADA-recognized national or international authority?

State whether the Applicant was outside of Russia in 2020 or 2021 to date, where and when (please provide specific dates), and whether he or she was there in an individual capacity or was under the control or supervision of RusAF or another Russian organization

Has the Applicant submitted a previous application to World Athletics under the previous IAAF Rule 22. 1A(b) and, if so, when (date)?

Confirmation that the application is accompanied by a letter of endorsement from each of RusAF and RUSADA

Confirmation that the application fee has been paid(See 2021 Guidance Note paragraph 6)

Tick the box:

Declaration and Signature

I affirm that the contents of this Application (and any accompanying documents) are true and that no facts have been omitted that a reasonable person would consider relevant

_______________________________ (signature)

______________________________ (date)

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