Академический Документы
Профессиональный Документы
Культура Документы
Date: _________________
I hereby certify that I have automobile liability insurance which covers the driver and all
passengers in the automobile and I have ascertained that my policy will cover myself and
all passengers riding in the automobile. ______________ (initials)
School activity and address/location of destination:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Insurance company: _________________________________________________________________________
Insurance agent and phone number: ______________________________________________________
Policy number: _______________________________________________________________________________
Drivers license number: ____________________________________________________________________
I certify that I have a current copy of my drivers license and proof of insurance on file in
the MCS office. ___________________(initials)
Revised 1/14