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The Driver Exclusion Form is a critical document used in the Philippine insurance industry to modify vehicle insurance coverage by specifically excluding certain drivers from policy coverage. This document becomes necessary when insurance companies or policyholders need to exclude high-risk drivers, those with poor driving records, or unauthorized individuals from operating insured vehicles. The form must comply with Philippine insurance regulations, including the Insurance Code and Land Transportation and Traffic Code. It typically includes comprehensive details about the excluded driver, affected vehicles, and explicit acknowledgment of coverage limitations. The document serves as a risk management tool for insurance companies and can help policyholders maintain more favorable premium rates by excluding high-risk drivers from their policies.

1. Form Title and Date: Clear identification of the document as a Driver Exclusion Form with date of execution

2. Policyholder Information: Complete details of the insurance policyholder including name, address, and contact information

3. Policy Information: Insurance policy number, effective dates, and vehicle information covered under the policy

4. Excluded Driver Information: Complete details of the driver being excluded including full name, license number, relationship to policyholder, and reason for exclusion

5. Exclusion Declaration: Clear statement that the named person is excluded from operating the specified vehicle(s) and that no coverage will be provided for any damages occurring while the excluded person is operating the vehicle

6. Acknowledgment of Understanding: Statement confirming that the policyholder understands that no coverage will be provided while the excluded driver operates the vehicle

7. Signatures: Spaces for signatures of the policyholder, excluded driver, and insurance company representative