Regn No: HARENG/2010/32259
Claimant Declaration Form
This form must be filled by an Organiser on behalf of the Claimant or by the Claimant himself. This
shall be forwarded to us before the record attempt.
Claimant Details:
First Name: ______________________________ Last Name: _____________________________
Date of Birth: ____________________________ Occupation: _____________________________
Mobile No: _______________________________ Email: __________________________________
Describe your record:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I acknowledge that the information given here are true to the best of my knowledge.
Signature of the Claimant ______________________________
(Need to be signed by the group head in case of a group/team record)
Signature of the Guardian: _______________________________
(If the record holder is below 18 year of age)
Note: ‘India Book of Records’ will not accept any responsibility for the safety of participants. It is the
sole responsibility of the claimant, to get insured and to ensure that all the necessary safety
measures and guards are taken in consideration. All the equipments and gadgets used are to be
thoroughly checked, prior to the record attempt. It has to further ensure that all required relevant
compliance with any Government or non-Government authority along with local health and safety
measures applicable at the time of the performance are in place.
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Rules for the Claimant to Attempt the Record:
You would be given specific set of Guidelines for the particular record category, which
provides you information in detail related to rules and regulation; you need to follow during
your record attempts. You must ensure that all participating candidates at the record
attempt are aware of the content of these guidelines thoroughly.
These guidelines are valid for attempting this particular record only. However, please be
aware that as and when required, India Book of Records may update the guidelines without
directly informing you.
Please choose any one of the options given below:
Option1 : (Put a tick in front of the suitable option)
Compiling and Sending Documentation
Once the record has been attempted, you have to compile mentioned evidences given below and
send it to our head office at address given below-
Photographs (can be used by author of ‘India Book of Records’ and other publications license
free. I acknowledge that the copyright is not owned by third party).
Newspaper Cutting /News channel Clippings
VCD/DVD
Logbook
2 Witness Statements
These documentations have to be sent to our head office where it will be reviewed in up to 25
working days.
India Book of Records,
121-B, Second Floor,
Green Fields,
Faridabad -121003, Haryana
Option 2: (Put a tick in front of the suitable option)
On Spot Certificate Ceremony
Instead of compiling and sending this evidence to be evaluated, it is possible to invite’. India Book
of Records’ Official Adjudicator to verify your record attempt on site. Our adjudicator will evaluate
your record attempt and will immediately announce the status, whether the record is made or not.
After on spot evaluation the record maker/breaker will be awarded with an official India Book of
Records certificate.
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Facilities with on Spot Certificate Ceremony:
The license to use India Book of Records brand name and logo to promote your record attempt
is also included in this Adjudication fee.
Press Invite and Press Release on letter head of India Book of Records
After successful attempt promotion of your record attempt on India Book of Records platforms.
Fast Tracking your claim and sending in three working days.
Record holders special pack and certificate without any charges.
If interested then can send the required information via email to ibr@indiabookofrecords.in along
with date and venue of the record attempt. The adjudication service comes with a fee (which may
vary depending on location and the number of records you will be attempting). Travelling expense
and accommodation of the adjudicator will be borne by you.
Terms and Conditions:
Appling for adjudication service doesn’t necessarily qualifies for attempt as a new record.
The claimant need to qualify all given guidelines to become a record holder.
Adjudicator fee is non-refundable.
Once the date is confirmed after the consent from both the sides, the event scheduled cannot be
changed.
I agree to the given terms and conditions.
Signature
(Name in Capital Letters)
Date:
Please note, you need to get written approval from India Book of Records of the final layout of
creatives and licensed material, prior to distribution or printing that bear India Book of Records
logo.
If you have any question regarding the specific guidelines or evidence requirement, you can contact
us via mail: ibr@indiabookofrecords.in or call: +919999436779 regarding any query.
Wish you good luck for your record attempt.
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