Regulations on Working With Intermediaries
24 March 2015
11 | P a g e
SCHEDULE B INTERMEDIARY DECLARATION FOR LEGAL PERSONS
Intermediary Details (Legal Persons):
Name of company
(legal person /
entity):
ACN / ABN:
Phone:
Email:
Website:
Company
Registered Address:
Address:
State / Territory:
Duly Authorised
Representative
Name:
Hereinafter referred to as “the company”
(NB: each individual acting on behalf of the company has to fill in this form of Intermediary Declaration
separately)
Declaration:
I, __________________________________________________________________
(First name(s), surnames(s) of the individual representing the legal person/entity)
duly authorised to represent the company,
DO SOLEMNLY AND SINCERELY DECLARE THAT:
1. I declare that both the company I represent and that I myself shall respect any mandatory provisions
of applicable national and international laws, including in particular those relating to job placement
when carrying out activities as an intermediary. In addition, I declare that both the company I
represent and that I myself agree to be bound by the statutes and regulations of Football Federation
Australia Limited (FFA) associations and confederations, as well as by the Statutes and regulations
of FIFA in the context of carrying out activities as an intermediary.
I declare that I am currently not holding a position of official, as defined in point 11 of the Definitions section of
the FIFA Statutes, nor will I hold such a position in the foreseeable future.
I declare that I have an impeccable reputation and in particular confirm that no criminal sentence has ever
been imposed upon me for a financial or violent crime.
I declare that neither the company I represent nor I myself have any contractual relationship with leagues,
associations, confederations or FIFA that could lead to a potential conflict of interest. In case of
uncertainty, any relevant contract shall be disclosed. I also acknowledge that the relevant company is
precluded from implying, directly or indirectly, that such a contractual relationship with leagues,
associations, confederations or FIFA exists in connection with its activities as intermediary.
Regulations on Working With Intermediaries
24 March 2015
12 | P a g e
I declare, pursuant clause 6.6 of FFA’s Regulations on Working with Intermediaries, that neither the company I
represent nor I shall accept any payment to be made by one club to another club in connection with a
transfer, such as transfer compensation, training compensation or solidarity contributions.
I declare, pursuant to clauses 6.1 and 6.2 of FFA’s Regulations on Working with Intermediaries, that neither
the company I represent nor I shall accept any payment from any party if the player concerned is a
minor, as defined in point 11 of the Definitions section of FIFA’s Regulations on the Status and
Transfer of Players.
I declare that neither the company I represent nor I shall take part in, either directly or indirectly, or otherwise
be associated with, betting, gambling, lotteries and similar events or transactions connected with
football matches. I acknowledge that both the company I represent and I myself are forbidden from
having stakes, either actively or passively, in companies, concerns, organisations, etc. that promote,
broker, arrange or conduct such events or transactions.
On behalf of the company I represent, I consent, pursuant to clause 5.2 of FFA’s Regulations on Working with
Intermediaries, to the associations obtaining full details of any payment of whatsoever nature made to
the company by a club or a player for its services as an intermediary.
On behalf of the company I represent, I consent, pursuant to clause 5.3 of FFA’s Regulations on Working with
Intermediaries, to the leagues, associations, confederations and/or FIFA obtaining, if necessary, for
the purpose of their investigations, all contracts, agreements and records in connection with the
activities as an intermediary of the company. Equally, I consent to the aforementioned bodies also
obtaining any other relevant documentation from any other party advising, facilitating or taking any
active part in the negotiations for which the company I represent is responsible for the purpose of
their investigations.
On behalf of the company I represent, I consent, pursuant to clause 5.1 of FFA’s Regulations on Working with
Intermediaries, to FFA holding, processing and publishing any data for the purpose of their
publication.
On behalf of the company I represent, I consent, pursuant to clause 8.4 of FFA’s Regulations on Working with
Intermediaries, to FFA publishing and informing FIFA of any disciplinary sanctions taken against the
company I represent.
I am fully aware and agree that this declaration shall be made available to the members of the competent
bodies of FFA.
I consent to the collection, use and disclosure of my personal information as described in this declaration and
for the purposes set out in FFA’s privacy policy (available at www.ffa.com.au), including administering
FFA’s Regulations on Working with Intermediaries.
I make this solemn declaration in good faith, the truth of which is based on the information and materials
currently available to me, and agree that FFA is entitled to undertake such checks as may be necessary to
verify the information contained in this declaration. I also acknowledge that, having submitted this declaration,
in the event that any of the above-mentioned information changes, I must notify FFA immediately.
______________________________ ________________________________
(Authorised Representative Name) (Authorised Representative Signature)
______________________________
(Place and date)
______________________________ _________________________________
(Witness Name)
click to sign
signature
click to edit
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