Vantastic Rental Car: Nominated Driver Registration Form
This form must be completed individually by each nominated driver in order to meet conditions of Vantastic Rental Car Insurance
Wheelchair Passenger Driving for: *
Your answer
Nominated Driver Details
Please input your own details below
Full Name *
Your answer
Address *
Your answer
Contact Number (Mobile) *
Your answer
Contact Email *
Your answer
Date of Birth (Eligible driving age 25-70 years of age) *
MM
/
DD
/
YYYY
Driving Licence Number *
Your answer
Driving Licence Category held *
Driving Licence Country of Issue *
Your answer
Date of Driving Licence Issue *
MM
/
DD
/
YYYY
Date of Driving Licence Expiry *
MM
/
DD
/
YYYY
Nominated Driver Declaration
In order to meet Vantastic Nominated Driver criteria you must confirm all 6 statements below by ticking boxes
I confirm: *
Required
I confirm *
Required
I confirm *
Required
I confirm *
Required
I confirm *
Required
I confirm *
Required
I confirm *
Required
Sign Off
Important Notice: Failure to disclose any details which fall outside the requirements above could result in an insurance claim being declined and insurance cover being invalidated. If for any reason you are in doubt please contact Vantastic.

By typing your name below, you are electronically certifying this Nominated Driver Registration Form just as if you would physically sign it if it was on paper.

Type Full Name here *
Your answer
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