Portsmouth University Student Union

Authorised Driver Application Form

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Please read and complete this form fully, sign the back of the document and submit it to the Student Activities Office along with your Plastic Drivers Licence and DVLA Code, the latter can be obtained via this link:

You won’t be insured until all parts of registration are complete.

Full Name / Date of Birth
Email / Date Passed Test
Address
(Term Time) / Contact Number
Student Number
Club/Department
Driving Licence Number / DVLA Code

Have you ever been refused motor insurance? Y / N

Have you any medical conditions that we should be made aware of: …………………………………………....

Do you have a full manual UK drivers licence? If no, please specify country/licence…………………………...

Do you have experience driving the following vehicles: (Please tick relevant boxes?)

CAR / VAN / MPV / MINIBUS

Are you happy to be contacted by other Clubs/Societies to drive for another group? Y / N

UPSU Driver Commitment

●I have read, understood and will adhere to the UPSU, Vehicle Transport Handbook (Hire One)

●I understand that there an excess for damage on all UPSU vehicles

●I understand I am liable for any speeding fines or points incurred during the time the vehicle is hired and in my care

●I will not allow anyone else to drive the vehicle (unless they are authorised, and where required additionally qualified, by UPSU

●I will ensure accurate details of passengers and itineraries are passed to UPSU prior to any trips, via the UPSU booking system

●I will carry out the daily checks prior to using the vehicle and will act accordingly should any of the checks fail

●I will ensure that the vehicle is returned fully fuelled.

●I will ensure that the vehicle is returned in a tidy condition, both interior and exterior

●I will promptly report any problems or incidents with the vehicle to UPSU and the hire company

●I will notify UPSU promptly of any changes to my personal details including fixed penalty notices, summons and convictions for any offence, as well as contact details

You will not be able to drive for your society or department until all the relevant paperwork is completed and documents submitted.

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE SIGNING THIS FORM:

Use of the vehicle(s) is for the purposes of UPSU business only. The carriage of goods or people for hire and reward is excluded.

  1. Neither you nor any person who to your knowledgewill drive the vehicles have:

●In the past 5 years been convicted of any motor offence or have a prosecution pending in relation to dangerous driving, drink/drugs, taking/stealing, failing to report an accident, driving without insurance or offences concerning the condition of the vehicles exceeding permitted hours of driving.

●At any time been refused insurance or quoted an increased premium or had special terms imposed.

●A disqualification that prevents them from driving a vehicle

●Suffered from any heart complaint, diabetes, fits or any other physical or mental infirmity that renders them incapable of driving an insured vehicle.

●Been regularly taking any prescribed medication, unless the condition has been notified to the DVLA and a licence to drive has been granted.

  1. All vehicles to be covered by this Policy are in roadworthy condition, belong to UPSU, are supplied to you under vehicle leasing agreement or lent to UPSU, but not by any employee, unless notified and agreed by UPSU’s Insurers.
  1. All vehicles to be covered by this Policy are registered in Great Britain,Northern Ireland, the Isle of Man or the Channel Islands, unless legislation does not require a specific vehicle type to be registered for road use.
  1. No vehicle to be covered has been modified from that stated within the manufacturer’s standard specification, unless notified and agreed by UPSU’s Insurers.
  1. No vehicle is used to carry inflammable, toxic, corrosive, explosive or other dangerous substances unless notified and agreed by UPSU’s Insurers.
  1. No vehicle is used at airports/airfields unless notified and agreed by UPSU’s Insurers

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  1. No vehicle is used for any business purpose other than the business declared, unless notified and agreed by UPSU’s Insurers.

Failure to comply with any aspect of this commitment may, in addition to any legal proceedings, lead to your authorised driver status being revoked.

Signed / Date

By signing this form I understand the rules of the driver's policy and

Will adhere to the USPU driving regulations.