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SOUTH CUMBRIA SEA SPORTS ASSOCIATION LIMITED (Reg. No. 06233323)

Established 1982                                                                     Web Page: www.scssa.co.uk

 

TRACTOR INSURANCE DECLARATION

All members wishing to drive the Association tractors are required to complete and sign the following declaration:

 

The Association is required to pass on details given to its insurers if anyone answers YES to any of the following questions.  Information given will be treated in confidence.

Numbering relates to the Insurance Form

7. Do you have any history of defective vision or hearing (not corrected by glasses or hearing aid), diabetes or any physical or mental infirmity or fits of any kind?    YES/NO

If YES, please give details below:

_________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _____________________________

You are reminded that you are required by law to inform Driverís Medical Branch, DVLA, Swansea, SA99 1AT, at once, if you have any disability including physical or mental condition which is, or may become likely to affect your fitness as a driver.

8. Have you:

a. been convicted during the past 5 years of any offence relating to theft, fraud or dishonesty? YES/NO

b. been convicted during the past 5 years of any offence in connection with any motor vehicles?  YES/NO

c. ever been disqualified from driving?        YES/NO

d. or had any prosecution or police enquiry pending?       YES/NO

If you have answered YES to any of these questions, please give details below:

_________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ ____________________________

I confirm the details given above are correct and agree to inform the Association if any of the details given subsequently change.

Name: _______________________________________________________________________________

Signed: ____________________________________   Date: ____________________________________

New members should pass this completed form to the Treasurer who will arrange appropriate training on the Association tractors.  A current year Association trailer disc/badge will be issued to boat owners after training.

Please note it is an offence and against the Association Rules for non-members or members not in receipt of appropriate training, or members not paid current subscriptions to drive the Association tractors.

Please note it is also an offence and against the Association Rules for paid-up members to launch/retrieve boats belonging to non-members or any boat over the Association limit of 600kg or from any trailer not displaying the current yearís disc.

 

Please return forms to:

Treasurer: G.Irwin, 3, CASTLE COTTAGES, MAIN ST, HAVERIGG, MILLOM, CUMBRIA.