<p> CAR/7/8 SEATER MINIBUS CARD NO. VAN </p><p>DATE OF ISSUE: AUTHORISED: </p><p>WARWICK SU AND WARWICK SPORT DRIVER APPLICATION To be completed by those people wishing to be insured to drive vehicles on behalf of Warwick SU and Warwick Sport</p><p>UNIVERSITY STAFF/STUDENT NUMBER NON EU DRIVERS NO ------HOW MANY YEARS DRIVING IN UK------</p><p>SURNAME FORENAMES</p><p>TERM-TIME ADDRESS </p><p>TEL NO EMAIL ADDRESS</p><p>AGE DATE OF BIRTH</p><p>CLUB/SOCIETY/DEPT (STAFF) UNIVERSITY COURSE</p><p>UK/EU DRIVER NO. DATE DRIVING TEST PASSED</p><p>WHICH CLASS OF VEHICLES HOW MANY YEARS DRIVING EXPERIENCE</p><p>Do you suffer from any form of illness or disability which has to be declared to the Authorities to obtain a driving licence? YES/NO If yes, please specify:</p><p>Have you ever been involved in any accident in connection with a motor vehicle? YES NO</p><p>DATE DETAILS OF ACCIDENT TOTAL COST (Own and third party)</p><p>Have you ever been convicted (or are there any prosecutions outstanding) for any offence in connection with a motor vehicle? YES NO If yes, give details below.</p><p>DATE OF DATE OF ACCIDENT TYPE OF CONVICTION CODE PENALTY POINTS OFFENCE NO</p><p>WARRANTY I warrant that the above statements are true and complete and there are no material facts which would influence the acceptance or assessment of my proposal. I warrant that a charge equivalent only to running costs will be made to persons carried in the vehicle and that the official capacity of the vehicle will not be exceeded.</p><p>I understand that any failure to disclose any material facts may prejudice entitlement to indemnity under the insurance contract and I will be liable for all consequences of such failure.</p><p>SIGNED: DATE NEWDRIVER PREVIOUS LICENCE : Card and Sheet PHOTO DEPOSIT D1 CLASS Associate Member DRIVER</p><p>Please Tick off all documents Received</p><p>14.08.13/ls</p>