Driver Exclusion Form Template for Nigeria

The Driver Exclusion Form is a critical risk management tool used in the Nigerian insurance market to modify existing auto insurance policies by formally excluding specific individuals from coverage. This document is typically employed when there is a high-risk driver in a household or organization, or when a company needs to explicitly exclude certain individuals from operating covered vehicles. The form must comply with the Nigerian Insurance Act 2003 and related regulations, requiring clear identification of all parties, specific details about the vehicles involved, and explicit acknowledgment of the coverage limitations. The Driver Exclusion Form serves as a legally binding amendment to the insurance policy, protecting the insurer from liability while ensuring all parties understand the implications of the exclusion. It's particularly relevant in situations involving commercial fleet management, family auto policies, and corporate vehicle programs.

1. Parties: Identification of the insurance company, policyholder, and the driver(s) being excluded from coverage

2. Background: Brief context explaining the purpose of the exclusion form and its relationship to the main insurance policy

3. Definitions: Key terms used in the document including 'excluded driver', 'covered vehicle', and 'insurance policy'

4. Policy Information: Details of the existing insurance policy including policy number, effective dates, and covered vehicles

5. Excluded Driver Details: Complete information about the driver(s) being excluded including name, license number, and relationship to policyholder

6. Terms of Exclusion: Specific terms stating that the named person(s) are excluded from operating the covered vehicles and that no coverage will be provided for accidents involving excluded drivers

7. Acknowledgment of Understanding: Statement confirming that all parties understand the implications of the exclusion

8. Signatures: Space for required signatures from policyholder, excluded driver, and insurance representative