Fillable Driver Check consent form (Accident Compensation Corporation New Zealand)

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Driver Check consent form (Accident Compensation Corporation New Zealand)

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The Driver Check consent form (Accident Compensation Corporation New Zealand) form is 1 page long and contains:

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Country of origin: NEW-ZEALAND
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Driver Check consent form
What is Driver Check?
Driver Check is a secure internet site set up by the NZ Transport Agency (NZTA). It has been established to allow companies to
check that only appropriately licensed drivers are driving their company vehicles.
What information can Driver Check tell the user?
Driver Check allows the user (eg your employer) to access the following information about your driver licence:
• thelicenceclassesyouhold,egaclass4licencetodriveheavytrucks
• thelicenceendorsementsyouhold,egaDendorsementtocarrydangerousgoods
• theconditionsonyourlicence,egtherequirementtowearcorrectinglenseswhendriving
• thestatusofyourlicence,egcurrent,expired,suspended,disqualied,revokedorreinstated.
The NZTA will send an automatic notication to the user when any of the above information about your driver licence changes,
eg when your licence expires or is suspended.
Licence holder’s consent
Driver Check’s terms and conditions of use require:
• theusertohavethewrittenconsentofthelicenceholderBEFOREaccessingtheirlicencerecord
• theusertoretainacopyofthatwrittenconsent
• theusertosupplyacopyofthatwrittenconsenttotheNZTAonrequest
• theusertohavethelicenceholder’spermissionBEFOREreleasinganyinformationobtainedviaDriverChecktoanythirdparty
• thelicenceholder’swrittenconsentonthisform.
I _________________________________ authorise ________________________________
(Licence holder’s full name) (Driver Check user’s full/company name)
to access my driver licence record using the NZTA’s Driver Check service.
Dated this _________________ day of ___________________________________ 20_____
Driver licence number: Licence version number:
(section 5a on your photo licence) (section 5b on your photo licence)
Signature of driver licence holder: ______________________________________________
Date of birth of licence holder: _________________________________________________
Signature of authorised signatory of organisation: _________________________________
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Driver Check consent form (Accident Compensation Corporation New Zealand)

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Completed 4 November 2021

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