Canada-Prince Edward Island Infrastructure Program
CLEAN WATER WASTEWATER FUND
Project Claim Form
You will find the Applicant Information on the
Project Outline (Schedule “A”) section of your
Infrastructure Funding Agreement. Please file one
APPLICATION FOR EXEMPTION FROM
NIGHT-TIME DRIVING RESTRICTION
Full Name _______________________________________________________________________________________________
Requirements of driver for class IV
1. Driver cannot be in the Graduated Driver Licence Program
2. Appointment fee
3. Current Medical certifi cate (must be completed and approved prior to road test)
4. Vision check
5. Vehicle pre-check
APPLICATION FOR REVIEW OF IMPOUNDMENT
Section 255.5 of the Highway Traffic Act
Section 255.8 of the Highway Traffic Act
Section 255.9 of the Highway Traffic Act
Surnam e First M iddle I.
Address: T el. N o.:
Reason for reporting:
day/m onth/year day/m onth/year
T he above-n oted co ndition has been discussed w ith the p atien t and/or fam ily m em ber: ¨ Yes ¨ No...
Department of Transportation and Infrastructure Renewal
Highway Safety Division
PO Box 2000
Charlottetown, PEI C1A 7N8
Request for Driver`s Abstract
Please note: cost for each abstract is $25.00.
If you require a driver`s abstract, for employment or insurance...