TOYOTA Driver Indemnity Form DRIVER INDEMNITY FORMDriver Full Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Email(Required) Driver Licence / Learner Permit Number(Required)Expiry Date(Required) DD slash MM slash YYYY Driver Licence Photo UploadMax. file size: 64 MB. Participants Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile Phone(Required)Other PhoneDate of Course / Program(Required) DD dash MM dash YYYY Driver AcknowledgementIn consideration of Toyota Motor Corporation Australia Limited ABN 64 009 686 097 of 494 Grieve Parade Altona North VIC 3025 (TMCA) allowing me to drive Toyota vehicles (vehicle) under the supervision of an experienced driving instructor (ITS Defensive Driver Program) I acknowledge and accept that: there are physical risks associated with driving a motor vehicle, and I agree to participate in the ITS Defensive Driver Program at my own risk; during the ITS Defensive Driver Program, TMCA may take photographs and audio-visual footage of, me (Content); TMCA has the right to use the Content for marketing and promotional purposes in any manner or any medium throughout the world, including over the Internet and social media platforms, and I consent to any act or omission by TMCA that would otherwise infringe my moral rights in the Content; and I have not received and do not seek to receive from TMCA any form of remuneration and compensation for the use of the Content; TMCA is not obligated to use any of the Content and any use by TMCA is an authorised use. I warrant that: I have a current driver’s licence, the details of which are correctly recorded above; I do not have a medical condition, and I am not taking any medication, that would affect my ability to safely drive a vehicle; I will not drive a vehicle under the influence of any drugs, alcohol or any other illegal substance; I will wear my seatbelt whilst driving the vehicle; I will not smoke cigarettes, including e-cigarettes, inside a vehicle; I will not allow passengers to be in the vehicle with me, unless expressly provided otherwise by TMCA, its staff or third party service providers (together, TMCA Personnel); I will only drive a vehicle within the designated course provided to me by TMCA Personnel, unless expressly provided otherwise by TMCA Personnel; I undertake to comply with all directions given to me by TMCA Personnel; I will not take any photos or record video for the duration of the ITS Defensive Driver Program I will not publish or otherwise disseminate any information or content of ITS Defensive Driver Program on any channel without TMCA’s prior written approval. By taking possession of the various TMCA vehicles as part of the ITS Defensive Driver Program, I acknowledge the following: TMCA will receive my Driver's Licence details so that it can provide those details to the relevant authorities (if required). All personal information will be managed in accordance with Toyota Australia’s Privacy Policy, which can be accessed at toyota.com.au/privacy. Please contact TMCA on 1800 869 682 if you would like to request access to, or correct, your personal information held by TMCA. If am involved in an accident during the ITS Defensive Driver Program, I understand I may be required to undergo a breath test and/or blood test to determine the percentage of alcohol in my body; If I am involved in an accident during the ITS Defensive Driver Program for which I was at fault, I agree to pay TMCA or its nominated third party the following (as determined by TMCA in its sole discretion): (a) an insurance excess at a maximum of $750 for each insurance claim made; or (b) an amount nominated by TMCA towards the cost of repair if no insurance claim is made; I will provide whatever assistance required by TMCA and its insurers in relation to any legal action or claim that may be taken against them or that they may make against their insurers or any third parties with respect to any accident that I am involved in during the Toyota Program; To the maximum extent permitted by law, TMCA is excluded from any and all liability for any damage or injury suffered by me in connection with my participation in the Toyota ITS Defensive Driver Program , including any such damage or injury suffered as a result of Toyota’s negligence; and I agree to indemnify, and continue to indemnify, TMCA and hold TMCA harmless against any and all losses, costs, expenses, damages, penalties, fines, infringement notices and claims (including claims of TMCA’s negligence) which may be suffered or incurred by or made against TMCA and/or its related companies and/or their officers, employees and agents in connection with or as a result of my participation in the ITS Defensive Driver Program Participant DeclarationDRIVERS SIGNATUREParticipant SignatureWitness DeclarationWITNESS SIGNATUREWitness Signature(Required)Witness Name(Required) First Last Licence Checked(Required) YES NO Send a copy of this form to TOYOTA(Required) YES NO