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WORKING WITHIN THE COMMUNITY SINCE 1987

DRIVER INFORMATION & DECLARATION

DRIVER INFORMATION & DECLARATION


Please provide details of any traffic Infringements received over the past 36 months (excluding parking fines)


Date


Details


Date


Details


I


 declare the following


The information contained herein is true and correct.
• I will notify Inclusion Plus Family Support Inc. in writing within 14 days of any change to these details, particularly in respect
to any new infringement received.
• I acknowledge that I will be personally responsible for any infringement received whilst driving an Inclusion Plus vehicle,
and that Inclusion Plus may seek reimbursement for any insurance excess payable as a result of a claim where it has been
determined I was at fault.
• I acknowledge that I am responsible for my own vehicle and that I have provided Inclusion Plus Family Support with a copy
of my current insurance policy and road worthy certificate.
• I have read and understood my obligations in relation to vehicle use as per the Policies and Procedures Manual.


Signed by


Staff Member


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