Sport Clubs Driver's Insurance Form 2016-2017
This form is required to be completed once per year per vehicle for all personal vehicles that are used for official Sport Clubs travel. The form must be completed once per academic year, and it remains valid for the entire year as long as the submitted vehicle information is correct.
Club Name
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Name
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Email
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Driver's License Number
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Driver's License State of Issuance
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Driver's License Date of Issuance
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Vehicle Owner
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Make/Model of Vehicle
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State Where Vehicle is Registered
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Registration Expiration Date
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Automobile Insurance Company
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Automobile Insurance Policy Number
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By typing my name below, I certify that I have automobile insurance coverage that meets the requirements of law in the State of North Carolina. I also certify that my driving record is satisfactory, and that the above information is correct. I understand that if an accident occurs while my car is driven during an official UNC Sport Clubs trip or activity that my autumobile insurance coverage may be the primary coverage. In addition, I certify that to my knowledge my vehicle is in good working condition and meets the State of North Carolina's vehicle inspection standards.
TYPING MY NAME BELOW INDICATES THAT I HAVE READ AND UNDERSTAND THE ABOVE STATEMENT TO BE TRUE, AND I ALSO CERTIFY THE ABOVE INFORMATION IS CORRECT TO MY KNOWLEDGE.
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