Driver Information Sheetform-Use For Privately Owned Vehicles
ADVERTISEMENT
1DRIVER INFORMATION SHEET
(Use for Privately Owned Vehicles)
Driver:
Name __________________________________
Date of Birth _____________________________
Address
___________________________
Social Security # __________________________
___________________________
Phone #
____________________________
Driver’s License # ________________________
Date of Expiration _________________________
`
Vehicle That Will Be Used:
Name of Owner
_____________________
Model of Vehicle __________________________
Address of Owner
_____________________
Make of Vehicle __________________________
_____________________
Year of Vehicle ___________________________
License Plate #
_____________________
Date of Expiration _________________________
Registration Expiration Date _______________
If more than one vehicle is to be used, the aforementioned information must be provided for each vehicle.
Insurance Information:
When using a privately-owned vehicle, the insurance coverage is the limit of the insurance policy
covering that specific vehicle.
Insurance Company __________________________________________________________________
Policy # ___________________________________________________________________________
Date of Policy Expiration _____________________________________________________________
Liability Limits of Policy* ____________________________________________________________
*Please note: The minimal, acceptable liability limit for privately-owned vehicles is $100,000/$300,000.
In order to provide for the safety of our young people or other members of the parish and those we serve,
we must ask each volunteer driver to list all accidents or moving violations they have had in the last five
years.
Especially Note: 12a-k of the Field Trip Transportation & Diocesan Vehicle
Policy.
____________________________________
________________________________________
____________________________________
________________________________________
Thank you for helping us with our transportation needs.
Certification
I certify that the information given on this form is true and correct to the best of my knowledge. I
understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license,
have the proper and current license and vehicle registration, and have the required insurance coverage in
effect on any vehicle used to transport students.
________________________________________ ________________________________________
Signature
Date
(3 yrs retention)
(T:\Forms\Driver Info.doc 3/20/02)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Vehicle Assessment Appeal Form For Condition Of Vehicle Or For High Mileage Adjustment - 2010
Financial
Information And Instructions For Completing Form De 3hwx - Annual Payroll Tax Return For Employer Of Household Workers
Financial
Related Categories
Parent category: Business