[2] The competition will be organised by the North Sumatra Provincial PSSI Association.
[1] Note: Flags indicate national team as has been defined under FIFA eligibility rules.
The first round will be played in a home tournament format of single round-robin matches.
All matches will be held at Mini Pancing Stadium, Deli Serdang.
The second round will be played in a home tournament format of single round-robin matches.