Taxi Association Membership Form

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Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Taxi Association Membership Form

Taxi Association Membership Form

ASSOCIATION LETTERHEAD

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Phone: {{association_phone}}

Email: {{association_email}}

Website: {{association_website}}

TAXI ASSOCIATION MEMBERSHIP APPLICATION FORM

Please complete all sections of this form clearly and accurately. Incomplete applications may be delayed or rejected.

Date of Application: {{application_date}}

SECTION A: APPLICANT DETAILS

Full Name: {{applicant_full_name}}

National ID/Passport Number: {{national_id_passport_number}}

Date of Birth: {{date_of_birth}}

Gender: {{gender}}

Residential Address: {{residential_address}}

City/Town: {{city_town}}

Postal Code: {{postal_code}}

Mobile Number: {{mobile_number}}

Email Address: {{email_address}}

SECTION B: VEHICLE DETAILS

Vehicle Make: {{vehicle_make}}

Vehicle Model: {{vehicle_model}}

Year of Manufacture: {{year_of_manufacture}}

Vehicle Registration Number: {{vehicle_registration_number}}

Chassis Number: {{chassis_number}}

Engine Number: {{engine_number}}

PSV (Public Service Vehicle) Permit Number: {{psv_permit_number}}

PSV Permit Expiry Date: {{psv_permit_expiry_date}}

SECTION C: DRIVING LICENCE DETAILS

Driving Licence Number: {{driving_licence_number}}

Issuing Authority: {{issuing_authority}}

Licence Class: {{licence_class}}

Expiry Date: {{licence_expiry_date}}

SECTION D: EMERGENCY CONTACT

Full Name: {{emergency_contact_full_name}}

Relationship to Applicant: {{relationship_to_applicant}}

Mobile Number: {{emergency_contact_mobile_number}}

Alternative Phone Number: {{emergency_contact_alternative_phone_number}}

SECTION E: DECLARATION AND AGREEMENT

I, {{applicant_full_name}}, hereby declare that the information provided in this application is true and correct to the best of my knowledge and belief.

I understand that membership is subject to the approval of the {{association_name}} executive committee. I agree to abide by the constitution, by-laws, and all regulations set forth by the association, as amended from time to time.

I consent to the association conducting necessary background checks to verify the information provided.

I understand that failure to comply with the association's rules and regulations may result in the termination of my membership.

SECTION F: MEMBERSHIP FEES

Application Fee: {{currency_symbol}}{{application_fee}} (Non-refundable)

Annual Membership Fee: {{currency_symbol}}{{annual_membership_fee}}

Payment Method: {{payment_method}}

Date Paid: {{date_paid}}

Receipt Number: {{receipt_number}}

SECTION G: FOR OFFICIAL USE ONLY

Application Received By: {{received_by}}

Date Received: {{date_received}}

Membership Number: {{membership_number}}

Approval Status: {{approval_status}}

Date Approved/Rejected: {{date_approved_rejected}}

Comments: {{official_comments}}

SIGNATURES

Applicant's Signature: _________________________ Date: {{signature_date}}

Secretary's Signature (on behalf of Association): _________________________ Date: {{secretary_signature_date}}