Sole Representative:
NIHONDEN KARATE DO SHOWAKAN JKF (JAPAN)
Member of Karate Association of India
Recognized By: Govt. of India (Ministry of Youth Affairs and Sports)
Affiliated with : World Karate Federation (WKF), Asian Karate Federation (AKF)
Commonwealth Karate Federation (CKF), South Asian Karate Federation (SAKF)
For further details contact : + 91 75677 79290
Sensei Kamlesh Patel
Shihan Kazuo Matsumura Chief Instructor, Examiner, Technical Director South Asia
Grand Master (Japan) Mobile : +91 98251 58557
Authorization No.
Instructor Authority Form
Instructor’s Name: Rank : Age:
School Name:
School Address :
Phone / Mobile : Fax :
E-mail ID :
Number of Dojo : Part Time Full Time
Number of Students :
Other Occupation of Instructor :
Years in Martial Arts / Karate : Style Name :
Other Instructor :
Past Affiliation : No. of Years :
Present Affiliation : No. of Years :
What is the reason of joining to the Shito-Ryu Karate Do India.
Note : Please include photo (passport size) and copy of present rank certificate
(A4 Size). Fill the form in capital letters.
GENERAL AFFILIATION INFORMATION:
1) The dojo instructor registration fee is Rs. 500.00 (one time) and annual instructor authorization fee
Rs. 1500.00 per year.
2) District chief instructor registration fee is Rs. 1000.00 (one time) and annual instructor authorization fee
Rs.2500.00 per year.
3) I and my students will also join the training seminars, tournaments, etc. organized by Shito-Ryu Karate Do
India.
4) Instructor should work on behalf of the SKDI Senior Examiner Sensei Kamlesh Patel.
5) No any instructor has a right or the claim renewal of the certificate as a matter of right.
6) Instructor should send the renewal fee to the Sensei Kamlesh Patel before the expiry date of Dojo, Dist,
and State affiliation.
7) Results will be given only from Head Quarter.
8) Please be reminded that individual membership, without the affiliation of Dojo is prohibited.
9) SKDI has the right to terminate or expelled my membership, if in case I found involved in any criminal /
civil offense / any act for spoiling the atmosphere, prestige and dignity of Karate Do.
10) I also declare that I have no objection in deputing any Dojo instructors and district instructors directly by
the head office or Chief Instructor of India.
Year personal progress and also progress of your karate students in your area federation will be monitored by
the SKDI Chief Instructor as per rules and regulation of the federation to consider extension of your further
affiliation.
I hereby affirm on oath as under:
1) I am intending to be legally bound hereby as a condition of membership of SKDI.
2) Students who are getting training under my instructions shall be examined finally by Sensei Kamlesh Patel.
3) I shall give all information of my all activities to Sensei Kamlesh Patel.
4) I shall not entertain any other organization and Karate Instructor.
UNDERTAKING:
I have read the above conditions and hereby agree to abide by the rules and regulation. Instructions sent from
time to time of the head office as well as the Dist. And State Association and SKDI with which this style is
affiliated. All matters concerning the instructors India’s Chief shall be subject only to the jurisdiction of the court
of law at Gujarat.
Name :
Rank :
Postal Address. :
Phone / Mobile :
E-mail ID :
Date : Signature
