Application for Membership

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Application for

Membership

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GOLD BAND TAXIS (CHRISTCHURCH) SOCIETY LTD

Share No. / Cab No.

APPLICATION FOR MEMBERSHIP

Membership Type: Full Member (Shareholder) Associate Member (Franchisee or Lease)

Full Name ___________________________________________Mr/Mrs/Miss Date of Birth _________________________

Address _______________________________________________________ Email Address____________________ Phone (Home/Mobile)____________ Operating Name (trading name)____________________________________ Are you now or have you been a Taxi Operator Yes/No

If Yes which taxi companies________________________________________ Have you driven a Gold Band Taxi Yes/No

If Yes, who did you drive for_______________________________________ For what period From _____________ To __________________ Previous business or employer_____________________________________

Name of TWO Referees

1. Name ______________________________________________________ Relationship _____________________ Telephone _____________________ 2. Name ______________________________________________________ Relationship _____________________ Telephone _____________________

Please confirm that we may contact the following people/parties to support your application and suitability to join Gold Band Taxis.

Present Employer Yes/No Past Employer(s) Yes/No Referees Yes/No Police Yes/No CIAL Yes/No Credit Check Yes/No NZTA Yes/No

Name _______________________________

Signed ______________________________ Date _____________________

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DETAILS OF PROPOSED VEHICLE

Make _______________________________ Model _______________________________

Type ________________________________Sedan/Station Wagon/Van Passenger Capacity ____________ (Note: Excluding Driver)

Month and Year ____________ /______________ Import Yes/No (First registered NZ or Overseas)

Is the vehicle already operating as a Gold Band Taxi Yes/No If so, as what fleet number ____________________

Has vehicle been approved for the fleet Yes/No

If yes, by whom _______________________ and when _________________ Distance travelled __________________km

Fuel Type _________________________ Registration No. ____________________

Note:

Vehicles proposed for the Gold Band Fleet must meet all the criteria listed on page 13 of the Information Booklet.

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ESTABLISHMENT COSTS (including GST)

Cost of Share or Franchise _______________

Vehicle Cost _______________

Insurance (must be commercial car policy) _______________ Income Protection Insurance (**) _______________ Passenger Service Licence _______________ P Endorsement Licence _______________ GB Drivers ID/Training (refer to page

12 of the Information Booklet, & add GST) _______________

Car set-up _______________

LPG installation _______________

Other vehicle costs _______________ Monthly Subscription (one month in advance) _______________

Stationery _______________

Admin / Registration Fee (refer to page

12 of the Information Booklet, & add GST) (**) _______________

Uniform Costs _______________

TOTAL _______________

FUNDED BY

Personal Funds _______________

Loans taken out (including car loan) _______________

Notes:

(**) We strongly recommend that all applicants take out income protection insurance, to cover regular outgoings in the event of the operator being temporarily unable to work. (Your monthly membership fees are payable regardless of whether the taxi is working or not!). Please sign here to acknowledge that you have been advised by to take out an income protection insurance policy:

______________________________ _______________ Date

(**) This Fee is payable in advance, at the time of lodging your application. Please bring your payment to the office with this completed Application Form.

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PROPOSED BUDGET – FIRST 12 MONTHS (all figures should be GST inclusive)

REVENUE (Income from fares, for 48 weeks) _____________ (A)

EXPENSES

Monthly Membership Fees (**) _____________ Lease of Equipment (MT Data) (**) _____________ Lease of Equipment (Eftpos) (**) _____________

ACC Levies _____________

Accountancy / Legal Fees _____________

Bank Charges _____________

Car Loan repayments - Principal _____________ - Interest _____________ Car Insurance (must be a commercial policy) _____________ Car Repairs, Maintenance, Tyres _____________ Car Registration & WOF _____________

Fuel _____________

Commission on dockets (**) _____________ Printing & Stationery _____________ Uniforms costs during the year _____________ General Expenses _____________

TOTAL EXPENSES _____________ (B)

PROFIT BEFORE DEPRECIATION & TAX (A – B = C) _____________ (C)

What you need as your own wages/”drawings” _____________

Notes:

(**) Refer to page 12 of the Information Booklet, & add GST

(**) All new members must process dockets via Gold Band and have their own TaxiCharge Merchant Number.

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STATEMENT OF ASSETS AND LIABILITIES AS AT /

/ 2014

This information should exclude the proposed purchase of the share or franchise

Liabilities Assets

Bank overdraft ___________ Bank deposits ___________ Bank term loans ___________ Motor Vehicles ___________ Hire purchase 1 ___________ Shares /

other investments ___________ 2 ___________

Life Insurance

3 ___________ Surrender Value ___________ Credit Card Balances ___________ Other assets ___________ Mortgages ____________ Property Value (GV) ___________ Other loans ____________ Chattels ___________ or liabilities

____________ Other ___________

____________ ___________

TOTAL ____________ (A) TOTAL ___________ (B)

TOTAL NET ASSETS (B – A = C) ___________

I________________________________________ hereby declare that the above information is a true and correct statement of my/our assets and liabilities.

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CHECKLIST – Applicant

The following information is required to be attached to the application:

 _{Copy of Drivers Licence and ID Card} _*

 P-Endorsement must be clearly shown on driver licence *

 Copy of Passenger Service Licence *

 _{Copy of Area Knowledge Certificate for Area 407} _*  Attendance at in-house training course (date ________________ ) *  Copy of in-house Permit Test (open-book) “Pass” certificate *  _{Copy of Assessment of Candidate (6-hour practical)} _*  Details of Company or Partnership (if applicable) *  Copy of proof of GST Registration (e.g. a copy of a blank GST return,

confirming your number) *

 Copy of Vehicle Registration Papers

(* = These items, once on file, together constitute a “Gold Band Permit”)

CHECKLIST – Board

 Date Application Received (date ________________ )  _{Notice on Gold Band Notice Board – including photo} _{(date ________________ )}  Date/Time to meet with Board (date ________________ )  Application Granted by Board? YES/NO (date ________________ )

 _{Agreed Effective Date} _{(date ________________ )}

 Any conditions attached to the Board’s approval:-

__________________________________________________

CHECKLIST – Staff Team

 Admin/Operations/ Tech Services Dept’s informed of approval? (date ________________ )  Date when vehicle has been booked for fit-out (date ________________ )  _{Fleet Number assigned to cab?} _{(date ________________ )}  Copy of Commercial Vehicle Insurance policy supplied? (date ________________ )  Signed Automatic payment form (for payment of fees) –

received by Admin? (date ________________ )

 Bank account details (payment for direct credit payments) –

received by Admin? (date ________________ )

 _{TaxiCharge Merchant Application completed? –}

or confirmation of current number (Note: All new members

must process docketsvia Gold Band Taxis) (date ________________ )

 _{MT Data & Eftpos Lease agreements signed?} _{(date ________________ )}  CIAL Airport Card Application Form received? –

or copy of current Airport Access Card/ID Card? (if applicable) (date ________________ )  Operator Agreement prepared and signed? (date ________________ )  Personal Guarantee signed? (for those trading via an entity) (date ________________ )  _{Copy of Constitution given to new member?} _{(date ________________ )}