Maternity of the Blessed Virgin Mary Catholic Church

Driver Information Form

Vehicle that will be used:

Insurance Information:

Please note: The minimal, acceptable liability limit for privately-owned vehicles is $100,0i00/$300,000)

Please be aware when using a personal vehicle, your insurance is primary. There is a policy that would offer additional liability protection should a claim exceed the limits of your policy.

Driving History:

Have you had any of the following citations or convictions in the past THREE years?

Please make a copy of your Insurance card & Drivers license and email to Carrie Rink at [email protected] OR Mail to MBVM Parish ATTN: Carrie Rink 308 E. Marsile St. Bourbonnais, IL 60914


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