Self-Declaration by Public Transport User and Cyclist

(This is applicable for All Public Transport (Bus/Train/ Cab/Auto) users and this document to be
attached with KRCC form at the time of joining)

Name : _________________________ Safety Passport

No:______________________________

Self -Declaration:
I understand that, unless authorized / permitted by VIL Line Manager, I am NOT
supposed to Change- Mode of Travel, while working for Vodafone. I understand that
Road Safety is very critical for Vodafone and driving 4 wheeler / Riding 2 wheeler for
Vodafone Business require following mandatory Road Safety controls :-
 Valid Driving License – Learners License is not permitted
 Vehicle Check by Vodafone Line Manager
 Declaration in KRCC
 Mode Change approval from Line Manager
 Defensive Driving Training
 Reflective Jacket & Reflective Sticker for Bike & Helmet

I am having Valid Driving license  Yes /  No

I am having Learner Driving License  Yes /  No
I do not Have Driving license  Yes /  No

Signature of Employee:__________________________________________________

Contractor / Distributor/ Agency Signature: __________________________________

Vodafone Line Manager- Name & Signature: _________________________________

Prepared and circulated by – Corp HSW Version 1, Dt.

21st Dec’2015