╨╧рб▒с                                                                                                                                                                                                                                                                  ье┴nozco  haber infringido  la(s)  regla(s)
Acknowlege  that I have infringed the rule(s)



Descripciєn  de los hechos  (usar croquis al dorso si es necesario)
Statement of facts (use diagram  at the reverse  if required)


























Hora de izada  de la bandera de autopenalizaciєn 	Lugar 	Firma
Time at which acknowledgement flag was displayed	Place	Signature

Fecha	Hora
Date	Time


A rellenar  por la oficina de regatas				To be filled by the race office

Fecha	Hora de recepciєn	Firma
Date	Received at	Signature
Nombre del receptor
Receiver's name

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