City of Greater Geelong Community Bus Hire
Annual Group Registration Application

Fields marked with Mandatory Field are required
Details
Mandatory Field Group/Organisation:  
Mandatory Field Postal Address:  
Mandatory Field Email Address:  
Mandatory Field Description of      
Group: 
Mandatory Field Group's Incorporation     Number: 
Contact person     (responsible for paying     account): 
Phone (Home): 
Phone (Work):
Phone (Mobile):
Public Liability     
Insurance Company: 
Policy Number: 
Expiry Date: 
Postcode or region     passangers are from: 

Public Liability Insurance
Attach a copy of your Certificate of Currency / Confirmation of Cover for our public liability insurance.

Mandatory Field Attach:  

Community Bus Hire Agreement Declaration

I declare that:

  • The vehicle will not be sub-let on hire or used for carriage of paying passengers.
  • I have answered all questions truthfully and not withheld any information likely to effect the insurance policy on this vehicle.
  • My Group / Organisation will reimburse Council for any damage caused by negligence or willful conduct.
  • My Group / Organisation will reimburse Council (1) the insurance excess of $1,000 in the event of a claim on Council’s insurance (2) the total cost of repairs in the event the driver acts in such a way as to invalidate the insurance cover.
  • The bus will only be used under the conditions outlined in the “Community Bus …going places” brochure and will be returned in a clean and tidy state.
  • All drivers will be made aware of the conditions of hiring the bus.
  • A copy of our Certifi cate of Currency/Confi rmation of Cover for our public liability insurance is attached.
  • My Group / Organisation will notify Council of any alterations to contact people and / or drivers’ details.
  • I understand that full payment is required within 30 days.

Name:  Committee representative/ Organisation manager's name
  
Title/Position:   
Mandatory Field Agree:  


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