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“Dial-A-Driver” Australia Pty Ltd Application for Preliminary ApprovalDisclaimer: Dial-A-Driver Australia Pty Ltdreserves the right to decline to provide or reveal confidential information and orintellectual property to the intending purchaser in the event the intending purchaser either refuses to seek approval to become aFranchisee of Dial-A-Driver Australia Pty Ltd or whose application is denied due to failure to meet the prerequisite criteria. Thelicensor may refuse to grant based on confidential assessment criteria and is not obliged to reveal the reasons why an applicationis approved or declined. The intending purchaser franchisee hereto acknowledges that heshe agrees to the above conditionsbefore making any applications.Location Territory _____________________________________ Post code__________________First Name ___________________________ Middle Name _______________________________Surname _____________________________ Partner _______________________________Status ___ Married ____ Single ________ Dependants ____________ Date of BirthLandline (____)__________________ Fax __________________________Mobile _________________________ Alt. Phone ___________________________Email _______________________________________________________________________Address 1_______________________________________________________________________Suburb ______________________________________________ State ________________Post Code ______________Status ________ Renting _________ Home OwnerLicence number ____________________________________________What is the total value of your assets $______________________.______Do you require finance YNDo you have a Criminal History YNHave you been disqualified from holding a licence YNHave you been disqualified as a company director YNHave you been bankrupt with in the past 15 Years YNDo you have a drug history YNAre you ready to commence training YNDo you require finance YNSkills __ Sales __ Advertising __Business __Finance __Accounting __OtherMain reasons(s) for becoming a Franchisee: __Income __Lifestyle __Challenge __Independence __OtherThe information supplied is true and correct __________________________________ Date_____________________ ( Sign Here as applicant )