Professional Unification of Martial Arts

This form should be used for students of the Professional Unification of Martial Arts to apply to take part in a black belt grading.

All fields are required as well as a passport style photograph (head and shoulders) of the applicant.

You should only submit your application with the express permission of your instructor, who will be notified of your application. Your instructor has the final decision on your ability to grade and can, if necessary, withdraw your application following submission.

Grading Date

First name

Surname

Email Address

Date Of Birth

Height (cm)

Licence Number

Expiry Date

Discipline

Start Date

Date of last grading

Request to grade to

Is this a retake?

Instructor / Assistant Instructor?

Referee / Umpire?

School

Name to be embroidered on belt

Belt Length

Any medical condition that may affect your grading?

Photograph

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P.U.M.A. Black Belt Grading Application