DRIVER AGREEMENT

All University staff and other individuals including students and contractors intending to use a
vehicle for University business must complete this form and have it AUTHORISED appropriately.
A copy is to be retained by the appropriate department manager.
Name of Driver:
Driver Date of Birth:
[must be over 21 years of age]
Driver Licence Number:
Driver Licence Issue Date:
Driver Licence Expiry Date:
Class of Licence(s):
Special Conditions:
Driver Licence has been signed:

Yes / No

Date:

Country of Issue:

I acknowledge that I have been provided with a copy of the Universitys Motor Vehicle Policy, and
have read and understood it, and agree to abide by the Policy. If the vehicle I am driving is not a
University vehicle it must be privately insured, have a current WOF and be fit-for-purpose. If I am a
student I may NOT drive other students unless I am specifically authorized to do so on this form.
I also acknowledge that any changes of circumstance related to the above details or my driving
ability must and will be advised to my Manager immediately. I acknowledge that failure to do so
may invalidate insurance cover and could result in disciplinary action. If an accident occurs and I
am found to be negligent I may be asked to reimburse the UOAs insurance excess.
Signature of Driver:
Date:

Drivers Manager to complete:

Drivers Licence has been sighted and approval has been given to the person named on this form
to drive a vehicle on University business.
Name of Authoriser:
Signature of Authoriser:
Authorised to transport students:

Yes

No

Date:

NOTE: in addition to the Universitys Motor Vehicle Policy there may be particular requirements
determined by individual departments regarding vehicle usage. It is the Drivers responsibility to
ensure they locate these instructions and comply.