Okinawa Gojuryu Karate Do India: Shihan Viraf Vatcha - Black Belt 7Th Dan

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OKINAWA GOJURYU KARATE DO INDIA


SHIHAN VIRAF VATCHA - BLACK BELT 7TH DAN
Founder & Chief Director : O.G.K.I
President : Karate Maharashtra Sports Association.
Treasurer : Karate Association of India (KAI)
Executive Committee Member : South Asia Karate Federation( SAKF)
Certified Kata & Kumite Coach : World Karate Federation (WKF)
H.O. Address – Maharukh Mansion, 170-A, Alibhai Premji Road, Mumbai – 400007.
Mobile : +91-9820008000, Tel : 022-3004569, E-mail : [email protected]  
Affix  Passport  
AFFILIATION / INSTRUCTOR AUTHORISATION FORM size  photo  

Reg No.__________________
Full Name : _____________________________________________ Age ________
Fathers / Husband’s name : _____________________________________________S
Address : __________________________________________________________________________
___________________________________________________________________________________
Phone / Mobile : __________________________ Email ID :__________________________________
Rank : ___________, Years in Karate : ___________ , Style Name : ____________________________
No of Dojo’s : ___________, No of students _________, Other Instructors : ____________________
Detail of Dojo and Address : __________________________________________________________
__________________________________________________________________________________
Past Affiliation :___________________________________________, No of Years : _____________

UNDERTAKING
I, ________________________________________ S/O._______________________________
R/O. ________________________________________________________________
Hereby under declare and confirm that I am joining the Okinawa GojuRyu Karate-Do India under the
chief instructorship of Viraf Vatcha with my own will and desire. All information given by me is true and
correct. I also declare that I have not joined any KAI approved style / or as an instructor before joining
the same and I will always abide by the rules and regulations of Okinawa GojuRyu Karate-Do India and
will work with full of my dedication and efforts to promote the prestige and dignity of Karate – Do. I will
also join the training seminars, tournaments etc. organized by Okinawa GojuRyu Karate-Do India.

Okinawa GojuRyu Karate-Do India and Viraf Vatcha has the right to terminate or expel my
membership, if in case I am found involved in any anti KAI / State Association or any criminal / civil
offence or by any act for spoiling the atmosphere, prestige and dignity of Karate – Do. I will also submit
my annual membership fees in time and submit the reports of my dojo and state / district activities from
time to time. I also declare that I have no objection in deputing any district instructor directly by Head
Office or Technical Director India.

I hereby agree to abide by all the rules / regulations and conditions as well as the instruction sent from time
to time from the Head Office and if any instructor wants to get any affiliation he / she is required to apply
to Okinawa GojuRyu Karate-Do India (India- Head Office)

Place : _________________Date : _____________ Signature : __________________

Sign and Seal : Name: ___________________________

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