Details of organisation wishing to use the vehicle (please provide details of group and a contact person)

Name

Address

Telephone

Email

Fax

Purpose for which the vehicle is required and destination

No. of passengers

No. of wheelchair passengers

Collection of vehicle

Time

AM PM

Return of vehicle         

Time

AM PM

Driver/s details : If more than one driver please show all details.

N.B. All drivers must be in possession of a current driving licence issued prior to 1997. (certain penalty points may exclude a driver from using the vehicle)

Name/s

Address

Tel. No./ Mobile No

I have read, understood and agree to the terms and conditions of use of the Community Transport Mini Bus and have completed the application form and enclosed full copies of the driver/s licence/s.

Date of application

Name of applicant

Status (i.e. job title, position in organisation, or group)

Signature

FOR OFFICE USE ONLY

When the application has been approved, sign and photocopy this document. Keep one copy and return one copy to the person/organisation wishing to use the vehicle.
 

Your application has been approved/not been approved

The keys may be collected

Enclosed are : Vehicle Condition Form, Passenger list, Conditions of use with insurance and emergency contact details.

In case of emergency please ensure that a completed copy of the passenger list is left at Reception before you depart.