Car Driver Registration Form

Section A: Personal Particulars

Full Name: THANABALAN GOVINDASAMY

(as per IC/Driving License)
IC Number: 860424387369
Gmail: thana7369@gmail.com
(MUST be same as Google Playstore for GrabPay/credit card cashout)
Home Phone:
Home Address: A2-2-04 BLOCK JATI DESA PUTRA,JALAN
BUNGA RAYA 2, TAMAN BATU CAVES,68100 BATU CAVES

Mobile Number: 60149524471

Phone Model:
IMEI:

Bank Name: MY | MALAYAN BANKING BERHAD

Bank Account Number: 157102518504
Own account?: Yes
Third Party IC/Company Reg No.:
(if applicable)
Emergency Contact Name: Relationship:
Address: Contact Number:
How did you hear about GrabCar: Social Media - Facebook
Referral ID/number plate (if any):

Section B: Driver Details

Driving License Type: D - Motor car (most common) Driving License Expiry: 24 April 2017
Public Service Vehicle (PSV) License: No PSV Expiry:
Has your driving license ever been suspended? No
Details:
Do you have any penalties (i.e. fines) for traffic offences within past 7 years? No
Previous Driving Experience: None - I only drive for myself Fleet:

Section C: Vehicle / Fleet Details

Car Model: TOYOTA VIOS Number Plate: PKW6090

Manufacture Year: 2012
Insurance Company: TAKAFUL IKHLAS Policy Number: MV3853640
Type of Insurance: Comprehensive Insurance Expiry: 30 January 2017
Are you using a company car? No
I certify that I have performed self-check on vehicle road worthiness for my car and confirm that it is in good
condition to drive. I will ensure that vehicle maintenance will be done regularly as per maintenance schedule
and repair work will be carried out when necessary on a best effort basis.
Section D: Declarations

Transport providers have close regular contact with the public, including children and vulnerable adults, and spend long hours
navigating challenging traffic conditions.Therefore, in addition to national licensing policy or the requirement of any authority, Grab
may employ background check specialists to ensure we work only with candidates of acceptable character and fitness to drive, in
order to ensure public safety. As an organization that believes in fair opportunities, Grab will provide due consideration for
candidates who choose to disclose all traffic and criminal offences:
Has your license ever been suspended?No
If yes, provide details:
Do you have any penalties (i.e. fines) for traffic offensces within past 7 years? No
Have you ever been convicted in a court of law? No
If yes, provide details:
Are you waiting for any kind of court proceedings against you? No
If yes, provide details:
Do you have any medical condition which may render you unfit to drive safely? No

I declare that I have read and completed this application myself. The information given here is true to the best of my knowledge and
I have not wilfully suppressed any material fact. I understand that any offer is conditional until the verification of any or all of the
information. Any false declaration, misleading or false information or the omission of a material fact and may render my application
invalid or termination of existing access.
I further declare that I shall be liable if I have knowingly or recklessly made a false statement or omitted any relevant information,
resulting in damages directly or indirectly sustained by Grab.
I understand that Grab may share this information with other agencies (never individuals) if necessary for prevention of crime or
disorder, or for purposes provided under applicable privacy laws. I authorise the verification checks to be made about me including
criminal convictions and the results of these checks to be communicated to the company. I understand that all information will be
kept confidential by Grab.
I agree that I will be responsible for any goods and services tax that may be chargeable on the commission that is levied by Grab and
this amount shall be deducted from the fares I receive. I agree to pay the commission from fares received via pre-payment at a rate
that be decided by Grab from time to time.
I agree to comply with such guidelines as may be issued by the Company from time to time.
I undertake to inform Grab within 14 days if I am charged with, or convicted of, any new criminal offence; receive a police caution;
am disqualified from driving; made the subject of a mental health or sexual offences order; or if my medical status changes in any
way that would affect my driving.
I confirm I have read and understood the declarations above, including the permissions contained
therein.
Supplement Terms of Use

By acknowledging, I declare that: I am in full understanding of all clauses stated in the above Driver’s Code
of Conduct. I will be solely responsible for any and all liability, which results or is alleged as a result of the
operation of my motor vehicle/passenger vehicle and/or taxi/passenger delivery service, including, but not
limited to personal injuries, death and property damages. I also stand culpable for damages sustained by the
Company if I am found to have contravened any of the clauses in the Driver’s Code of Conduct. I understand
and agree that the Company has the right to take such appropriate actions against me, including suspending
or terminating my access to the Grab application in the event I breach any of the clauses of this Driver’s
Code of Conduct (dated 23 July 2015). I am also reminded to regularly review the “Terms and Conditions For
Drivers” as stated on http://grabtaxi.com/terms-driver/

Background Check Authorization

I hereby authorize the complete release of these records or data pertaining to me which an individual,
company, firm, corporation, or public agency may have. I further authorize the full release of the information
described above, without any reservation. It is confidential and will not be used for any other purposes other
than for verification when checking records. I hereby release White Unicorn Inc. (Company No. 297740) and
its agents, officials, representatives, or assigned agencies, including officers, employees, or related
personnel both individually and collectively, from any and all liability for damages of whatever kind, which
may at any time, result to me, my heirs, family or associates because of compliance with this authorization
for use of my information.

Full Name: THANABALAN GOVINDASAMY

(as per IC/Driving License)
IC Number: 860424387369
Mobile Phone: 60149524471
Home Address: A2-2-04 BLOCK JATI DESA PUTRA,JALAN BUNGA RAYA 2, TAMAN BATU CAVES,68100
BATU CAVES

Date and Time: Nov 7, 2016 12:36 PM

IP Address: 14.1.193.217