Owner Information
Owners Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
TRN
GCT Registration #
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Owner Emergency Contact
Emergency Contact
First Name
Last Name
Emegency Contact Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Driver Information
Driver's Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License
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Driver Emergency Contact
Emergency Contact
First Name
Last Name
Emegency Contact Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Delivery Assistant's Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
TRN
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Vehicle Informatin
Truck Model
Truck Year
Vehicle Registration #
Truck size
Type of Insurance Coverage
Insurance Company
Insurance Expiry Date
-
Month
-
Day
Year
Date
Fitness Expiry Date
-
Month
-
Day
Year
Date
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Form to be submitted with
Photographs of both owner & driver (if differ) & delivery assistant
Copy of Driver's License
Two recommendations: JP, Pastor, Lawyer or Past Employer
Copy of police record
List of the last 3 companies you did haulage for
Copies of all supporting documents for the truck
Public Carrier's License
Email above documents to - Operations@dflimporters.com
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DECLARATION:
I declare that the information stated in this form to be true and correct.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: