Home - Taxi Taxi

TAXI TAXI
A DIVISION OF 526093 ONTARIO INC- 164 BLOOR STREET EAST, OSHA WA,
ONTARIO, LlH3M4
PHONE: 905-571-1234 FAX: 905-725-4771
E-MAIL: MANAGt:Rr,,:TAXI-TAXI.CA
TAXI DRIVER APPLICATION
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NAME:
DATE OF BIRTH (DDMMYY)
POSTALCODE
ADDRESS
TELEPHONE(HOME)
CELL.
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smFTS PREFERRED (DA YI NIGHT)
DA YS OFF PREFERRED
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PHONE#
NEXT OF KIN
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ARE YOU ABLE TO OBTAIN INSURANCE EXPERIENCE LETTER (YESI NO)
THIS LETTER MUST BE FOR 3 YEARS PERSONAL WITH NO GAPS OR ONE YEAR
COMMERCIAL.
I, THE UNDERSIGNED, UNDERSTAND THAT IF CHARGED WITH A HIGHWAY TRAFFIC ACT
OFFENCE, RECEIVE A PARKING TICKET, OR ARE INVOLVED IN ANY ACCIDENT OR
CONFRONTATION I MUST REPORT THESE TO THE OFFICE. I FURTHER UNDERSTAND THAT
IF INVOLVED IN AN ACCIDENT WHICH IS DEEMED TO BE MY FAUL T I WlLL BE RESPOSlBLE
FOR THE DEDUCTIBLE PORTION OF THE INSURANCE. I ALSO UNDERSTAND THAT THERE
MAY BE A SURCHARGE LEVIED BY THE INSURANCE COMPANY FOR DRIVERS WITH AT
FAULT ACCIDENTS .
. I ALSO UNDERSTAND THAT I MUST FOLLOW ALL CITY BY-LAWS REGARDING TAXI
DRIVERS ( SEE AITACHED) AND OBEY ALL COMPANY POLICIES AND PROCEDURES.
IT IS UNDERSTOOD THAT I AM CONSIDERED AN INDEPENDENT OPERA TOR AND
THEREFORE I AM SELF-EMPLOYED.
SIGN
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PRINT
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Driver's Pre-qualification Application
As a member of the Taxi and LImousine Drivers Association, I hereby apply for pre-qualification as a
basis for an application for Insurance coverage under the Group Marketing (Automobile Insurance) Plan
(the II'Planll')sponsored by the Taxi and limousine Drivers Association. l understand that I must meet
the underwriting criteria and Driver Acceptance Qualifications specifled by Arch Insurance
Company, the Insurer tor the Plan sponsored by the Taxi and limousine Drivers Association In
order to qualify for automobile Insurance under the Plan. If I fall to meet the underwriting
criteria and Drivers Acceptance Qualifications, I understand I may not qualify for Insurance
coverage under the Plan.
In support of this pre-qualification application, Iauthorize the Taxi and limousine Drivers
Association to provide the Information contained In my application for membership to T&L
Insurance Services Inc. or Its designate. In addition, I provide the followIng Information which I
certify to be true and correct:
1. Motor Vehicle Record (MVR), specifically a "3-Year Ontario Abstract Without
Address", not more than ~O days old. If I am unable to produce this level Abstract, I
hereby authorize T&L Insurance Services Inc. or their designate to obtain my
Abstract at my cost of $15.00
2. Claims History Letter(s) from your previous Insurer(s}, specifically (a) One Year of
uninterrupted claims hIstory from an Insurer{s) for commercial automobile
Insurance, or, if not available, (b) Three Years of uninterrupted claims history from
an lnsurer(s) for personal automobile Insurance.
In connection with this pre-qualification application, Iprovide consent for Creggan Insurance
Brokers Inc. ("CIB"), Insurance brokers for the Plan, to, without personal cost to me, obtain a
Consumer AutoPlus Report which provides my Individual automobile pOllcy(les) and clalms
history as reported by the Canadian Property and Casualty Industry. This consent Includes my
consent for the Consumer AutoPlus Report to become the property of CIS and to be disclosed
and copied by CIBto T&llnsurance Services Inc, or Its designate.
I understand, acknowledge and agree that completion of this pre-quanflcatton application does
not constitute an application for Insurance coverage and Is only for the purpose of determIning
whether I satIsfy the underwriting criteria and Drivers Acceptance Qualifications necessary to
confirm eligibility for the Plan. I understand that my signature below does not guarantee or
confirm that Insurance coverage under the Plan Is In place at the time of signing or that Insurance coverage under the Plan will be forthcoming If I fail to meet the underwriting criterIa and
Driver Acceptance Qualifications applicable under the Plan.
Signature:
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Witness:
Name:
_____
Date:
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Appllutlon
Personal Information:
Name:
Address
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Cell Phone
Home Telephone.
Fax Number ----_ ....
for Mcmbea'shlp in the Taxi and Limousine
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Drivers Association
RIN#I
City
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HSTN
Taxi or Limo License #
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Membership Services:
I acknowledge that the Taxi and Limousine Drivers Association offers a range of optional and elective
products and services, including through sponsorship of automobile insurance under a Group Marketing
(Automobile Insurance) Plan, all as more specifically described on the member services pamphlet which I
have received or have been provided access to. The products and services of initial interest to me are
those which I have designated in connection with this Application for Membership, If my election
includes the Group Marketing (Automobile Insurance) Plan, I understand that I will be required to first
complete a J)r(ver's Pre-Qualification
Application in order to determine whether I meet the
underwriting criteria and Driver's Acceptance Qualifications specified by the insurer of'the Group
Marketing (Automobile Insurance) Plan.
PrivAcy Policy and Consent
With respect to the "Personal Information"
provided in this Application, J understand, acknowledge and
agree that such "Personal Information" is subject to, and is protected by, the "Privacy Policy" of the Taxi
and Limousine Drivers Association. I hereby acknowledge receipt and understanding of such "Privacy
Policy" and con finn my consent to the provisions of such "Privacy Polley". including the sharing of
"Personal Information" among the parties covered by, and committed to abide by, such "Privacy Policy",
including as to the safeguarding of "Personal Information." I further and specifically consent to the use of
my driver's license number or my Registrant Identification Number (RIN) as my membership number on
my membership card and associated records.
Additional
Consent (Driver Applicants
Only>
If! am making this application in the capacity as a taxi or limousine driver, I understand and agree that I
must demonstrate that my driver qualifications meet the driver eligibility criteria endorsed by the
Association as a condition for membership. In this regard, I agree to provide the following information
which I certify to be true and correct:
I. Motor Vehide Record (MVR), specifically a "3-Year Ontario Abstract Without Addl'CSS",
not more than 30 days old. IfJ am unable to produce this level Abstract, I hereby authorize '1'&1.
Insurance Services Inc. or their designate to obtain my Abstract at my cost of $l5.00
2. Claims History Letterfs) from my previous insurer(s), specifically (a) One Year of un interrupt ed
claims history from my lnsureus) for commercial automobile insurance, or, ifnot available, (b)
Three Years of uninterrupted claims history from my insurcr(s) for personal automobile
insurance.
I understand and agree that acceptance of my Application for Membership will be contingent upon my
satisfaction of the driver qualifications and standards established by the Association as appropriate for
members of an occupational association consisting of professional taxi or limousine drivers entrusted to
safely provide public transportation services, I also understand that member benefits are available to me
~nly upon issuance of my membership card and only for the duration that I remain a member in good
standing.
Signature:
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fr"e~....""'"
I
Date:
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Driver Declaration Form
This declaration is made in connection with an application for automobile insurance with the intent that it
will be relied upon by all parties of Interest
Name as shown on Driver's license:
Driver's License Number:
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Please answer the following based on your best information and belief:
IJI declare
that
I am Accident
and Claims free for the past five years
(Initials)
Previous Accidents and Insurance Claims:
Accident
Incurrod
DatG(OOIMWYY)
At
Closed? Insurance Company
Fault 1
Short Description
I authorize access to prior insurance companies for full and further details
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->Initia/s)
I authorize attainment of motor vehicle records (Abstract) and Auto Plus Report __
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(lnili8/s)
I declare that I have disclosed all accident information and all convictions as at the date of this Application.
I declare that I do not suffer from any Illness, condition or addiction of a nature requiring notification to the"
Ministry of Transportation or of a nature that, if disclosed to the Ministry of Transportation, would disqualify
me for a driver's license in Ontario. I understand that it is an offence of the Insurance Act and of the
Criminal Code to knowingly make a false or misleading statement or to provide misleading information
or omitting to provide material information for the purpose of inducing an Insurer to provide Insurance .
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Signature of Declarant
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Date
For Privacy Polley and details on the protection of Personal Information please vlsK: www.hsfleet.com
H & S FLEET SERVICES INC.
rrlyacy
PoliCY
When you become a client ofH '" S you share important personal infonnatlon with us. We are committed to protecting the
privacy, confidentiality, and security of the personal infonnation and ensuring the accuracy of the persollal information we collect,
use, retain. or disclose in the course of doing business. TIle principals In this privacy policy guide our employees and affiliates in
this matter.
Perlonal Informationj
We define "personal information" as - oral, electronic or wriucn personal details that are identifiable to all individual including
(but not limited to):
Date ofbinh. personal address And telephone number, family status, age, gender. family and material status. driving
record, previous insurance and claims experience, banking Information, credit rating, and payment records. We collect this
personal information because it Is essential to the services thilt we provide eithcc directly to you or obtain through other
sources on your behalf.
Idtlltifird Jlt![!losrs for colltc!lnc personalln[orrnllllooj
H & S typically collects, uses and discloses personal information for the following purposes:
- Assessing insurance applications.
Communicating And negotiating with insurance brokers.
- Risk management
- Providing information about upgrades to coverage
~ Determining and facilitating your payment of fees and premiums
- Arranging for financing of Insurance premiums
- Establishing and maintaining communications with you
- Verifying your identity and the accuracy of your pcrsonallnformation Industry associations, brokers, adjusters and
taxi brokerage flnns, plate owners and lessees, municipal by law enforcement body(ics)
- Evaluating and investigating claims
• Detecting, investigating or preventing fraud or other illegal activities
- Annlysing business results
- Compiling statistics
Consent (or the '011$£11011,lI~eor dlsdosure o(nusonallnrormatjolli
Your knowledge and consent are required before we may collect, use or disclose your personal information. Consent may be
express or Implied.
Express consent is explicit and obtained through verbal or wriuen means. Implied consent is Inferred when the purpose for which
personal information is collected is obvious by the very nature of the transaction.
We accept any of the following as your consent for 11& S existing usc of future collection, use or disclosure of your personal
informatkm for identified purposes.
- Receipt of chis personal information policy, unless you advise us otherwise In writing.
- Your express oral consent when dealing by telephone
- Your written consent
- Your consent 8.'> provided by your authorized representative, a guardian or power ofattorncy
- If you have an existing Insurance policy and you request amendments to the policy
- For us to provide you with on-going coverage, it is assumed Illat the consent, verbal or written that you gave to us whcn you
originally purchased the pulicy or requested a quote remains in effect.
[f your personal information is not for one of the "identified purposes" listed, we will not use or disclose it without obtaining
additional consent from you.
Consent to the use of and disclosure of your personal information can be withdrawn by notice in writing to H &. S.
Please note however, that withdrawal of your consent may result in us being unable 10 continue to provide services to yOII.
I! & S may disclose personal information to third parties who are necessary to assist in the provision of services.
Examples of such third parties arc Insurers, other brokers, risk managers, associations related to program business,
premlum finance organi7.ations. banks. mortgages. lien holders, lessors, claims adjusters, investigators. lawyers,
accountants and others involved ill the claims handling process.
These orgenizations arc limited in how they may use personal infonnation and !hey arc obligated to protect the privacy of
information with which they have been provided.
Retention ofpersonalillfornlal!onj
H'" S keeps personal information only as long 8S it remains necessary in order to meet and maintain your insurance needs
or lIS required by law.
Snregllllrds ofyollr !!t[IOIIIII in(orOlptlollj
Whcther electronic or paper-based format, If &: S maintains security systems 10 protect your personal infonnation from
unauthorized access, disclosure or misuse. Access is granted only to those who require il for nuthorized purposes.
As well, when we no longer need your Information, we take as much care to destroy it as we do when storing it.
At£urosy and !!SSEn;
II '" S takes reasonable steps necessary to ensure that your personal information Is accurate and up-to-date. Of course, H & S relics on
lIs clients and its third party suppliers to provide 1111
material information and to notify us of any changes. You have the right to access,
review and if applicable correct the personal information held by us. However. the right to IICceSSis not absolute and there are certain
exceptions established by law. For example, if the illfoonation which is requested is subject to a legal privilege, is confidential
commercial informaticn, or would give you Access to someone else's personal information the request may be declined.
A request for access to your personal infom18tioll cun be made ill writing. Such request must provide satisfactory identification and
proof of entitlement.
Sigualure: __._.
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Date: