Fare Evasion Incident Report

* denotes a mandatory field

Driver details
Driver name: *
Driver ID: *
Taxi plate number: *
Driver contact number/s: *
Taxi dispatch service: *	Select Black White Taxis Cabwest Carlisle Cabs Coastal Independent Mandurah Taxis Painbow Taxis Red White Reliable Sorrento Cabs Sunshine Swan Taxis Tricolor White Eagle Yellow Cabs Other
Time, date and location details
Incident date: *
Incident time: *
Was Taxi booked through Taxi dispatch service: *	Select Yes No
If yes, please supply Job number (if known)
Passenger pick up location (address): *
Passenger drop-off location (address): *
Passenger physical descriptions - Hold down SHIFT key to select multiple choices
Number of passengers:
Sex:	Select Male Female
Age:	Select Teenage 20 - 25 25 - 30 30 - 35 35 - 40 Older
Height:	Select Tall Average Short
Build:	Select Slim Average Muscular Large
Skin colour:	Select Light Olive Tanned Dark
Hair colour:	Select Blonde Brown Black Red Grey Bald
Hair length:	Select Shaved Short Medium Long Other
	Other:
Other distinguishing features (eg. Tattoos, piercings, accents etc):
Passenger name (if known):
Passenger phone number (if known):
Other passenger details (if known):
Fare details
Fare amount: *
Was fare requested: *	Select Yes No
Incident details
Details of the incidents: *
Declaration
I declare that the information provided in this report is true and correct to the best of my knowledge. I understand that knowingly providing false information is an offence. *
Name of person submitting report: *