Client Application
Please complete this form with as much detail as possible.
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AC Driver is a business concerned with Driver Development.

We are a DVSA registered business with Crown Office approval to use the official DVSA logos. 

We are also registered with The Information Commissioner's Office, which requires us to treat your data securely.

We are also members of:
> Association of Road Risk Managers
> Driving Instructor Association
> Disability Driving Instructors Association
> Approved Driving Instructors National Joint Council

We protect ourselves and our clients with:
> Public Liability Insurance (£20m)
> Professional Indemnity Insurance (£5m)
This document sets out the information we need to set you up as a client. 

Where requested please send supporting information (licence photos and check codes) to info@acdriver.co.uk

If you have any addition information which is not specifically requested within this form and you think it will be needed, please add it to the EXTRA INFORMATION section near the end of the form.
Full name *
Telephone number *
Email address *
Full address *
Postcode *
Driving Licence Held
 *
Please provide your driving licence number
Captionless Image

Please provide a check code (case sensitive) for your licence which can be obtained here check code (to prevent errors we recommend to copy and paste)

Please send photos of the front and rear of your driving licence
(send to info@acdriver.co.uk)
Please send a screen shot of your driving licence check code
(send to info@acdriver.co.uk)
Do you have a driving test or assessment already arranged? *
Yes
No
Tests or assessments arranged
Please give full details of your driving history/experience including any driving lessons, tests or assessments arranged or already taken *
Please send any driving test or assessment reports
(send to info@acdriver.co.uk)
Please give details of any special needs, allergies or medical conditions (or state NONE) *
Do you have any condition/s which affect your ability to drive?
 *
Please give details of your condition/s which affect your ability to drive
Have you informed DVLA of the condition/s which affect your ability to drive?
 *
Has a Doctor or other medical professional advised you not to drive? *
Do you require adaptions fitted to a car in order to drive? *
Required
Have you already completed a Mobility Driving Assessment?
(send the report once received to info@acdriver.co.uk)
 *
What is your driving goal?
 *
Required
Can you get in and out of a car without help? *
Do you use any aids to mobilise? (stick, rollator, wheelchair, scooter etc) Please add details to EXTRA INFORMATION below *
EXTRA INFORMATION
Please add any extra information you wish or need to share here
Have you read and accepted our Terms and Conditions? *
Yes
T&Cs read
When are you available for lessons? *
9-11am
12-2pm
3-5pm
None
It varies
Monday
Tuesday
Wednesday
Thursday
Friday
How often are you available? *
Same day & time each week
I work shifts / it changes
I really need an intensive course
Regularity
Thanks for completing this form.

We will review your submission and respond promptly.

Kind regards,

AC Driver
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