Non-Profit Vehicle Driver Addendum Form
Driver Information
Driver's Full Name
Date of Birth
Driver's License Number
Issuing State
License Expiration Date
Contact Phone Number
Vehicle Information
Vehicle Make
Vehicle Model
Vehicle Year
License Plate Number
Insurance Company
Policy Number
Policy Expiration Date
Driving History
Have you been involved in any vehicle accidents in the past 3 years?
No
Yes
If yes, please provide details
Have you received any driving citations or violations in the past 3 years?
No
Yes
If yes, please provide details
Certification & Consent
I certify that the above information is true to the best of my knowledge and I consent to allow the organization to verify my driving record and insurance coverage.
Driver's Signature
Date