has successfully completed the TCWR Orientation and fully
understands the Current Winter Road Rules and Regulations.

Driver Signature:_____________________________________________________

Employer: __________________________________________________________


Representative’s Signature:____________________________________________

Driver Road Number (if applicable):______________________________________

NOTE: A copy of this declaration, duly signed by the trucking company or Road Contractor’s representative who conducted
the orientation and a copy of the competency quiz must be filed at the Trucking or Road Contractor Company’s office upon
completion of orientation and prior to you being dispatched northbound for your first winter Road trip. If a Driver on the road,
you will be required to provide a second signed copy of this document to Yellowknife Dispatch for the purpose of authorizing
and identifying your assigned Road Number.