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:
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Nominated Driver Details
Please input your own details below
Full Name
Your answer
Address
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Contact Number (Mobile)
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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
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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
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
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