METAFORA

APPLICATION FORM

Date: (DD/MM/YY): _______________________

First Name: _______________________________ Last Name: _______________________________

Date of Birth: (DD/MM/YY) _____________________________________________________________

Address of Applicant: __________________________________________________________________

Place of Birth: _________________________________________________________________________

Cell #: _________________________________ Home #: ________________________________

National ID Card Number or Passport Number: ___________________ Expiration Date: _________

Drivers Permit Number: __________________________________ Expiration Date: _________

Taxi Driver’s Barge/License Number: ______________________________________________________

Sex of Applicant: ______________ Age Of Applicant: ______________ Marital Status: ______________

Route and specific area along route to be operated by the applicant: ______________________________

How long have you been licensed to drive a motor vehicle? _____________________________________

Have you ever taken a defensive driving course? ________ If yes what date? ___________________

Are there any charges pending against you for any criminal offences or have you been found guilty or
convicted by a court in ACT or elsewhere of any criminal offence in the last ten (10) years?
_____________________________________________________________________________________

_____________________________________________________________________________________

EACH APPLICATION WITH SUPPORTING DOCUMENTS RECEIVED WILL BE REVIEWED AND
ASSESSED IN ORDER TO MAKE A DETERMINATION. EACH APPLICANT WILL BE NOTIFIED OF THE
DECISION MADE IN RELATION TO EACH RESPECTIVE APPLICATION.

___________________________________________
APPLICANT’S NAME IN BLOCK LETTERS

I certify that the information given in this form is true to the best of my knowledge, information and
belief. If there is anything in the information provided above which is not true or which I do not verily
believe to be true, I understand that Metafora can refuse my application.

Date: (DD/MM/YY): ____/____/____ Applicant’s Signature: _______________________

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