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Passenger Assessment Questionnaire

Passenger Assessment Questionnaire

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All information provided is treated as confidential.

Personal Details

For example, Miss, Mr, Mx, Dr.

Your Mobility

For example '20 metres'.
For example '30 metres'.
For example, 'Volkswagon'.
For example, 'Polo'.
A Hatchback with two passenger doors is considered to be a 'three door'. Only include passenger doors here.

Declaration

I hereby declare that all the above information is correct to the best of my knowledge.

Clear Signature

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