For The 8 Hour Black Car Fund (BCF) Defensive Driving Course

Step 2 - Complete all the information below and click on the "Submit Request" button at the end of the form.


 Date:  

 Location:  

 Class Requested:
 

 First Name:
 

 Last Name:
 

 Social Security Number:
  - -

 Date of Birth:
  mm/dd/yyyy

 Address:
 
 NOTE Please enter the address of your current residence.
 This is the address your check will be mailed to.

 City:

 State:   Zip:

 Cell Number:
 

 Driver License Number:
 

 TLC License Number:
 
 NOTE: Non-TLC Driver - Enter NA

 TLC Plate Number:
 
 NOTE: Non-TLC Driver - Enter NY State vehicle plate number.

 Company Base:
 
 NOTE Please select your company base from the list.

 Email Address:
 

As a driver for a Black Car base, you can be automatically enrolled in Drivers Benefits. Through the Drivers Benefits Program, The Black Car Fund provides Health and Wellness benefits to eligible enrolled drivers who drive for Black Car Member Bases in the state of New York. These benefits include Accidental Death Insurance, Critical Illness Insurance, Dental Insurance, Vision Coverage, Telemedicine and more, at no cost to you. For specific benefit coverage details, exclusions and eligibility information, see ny.driversbenefits.org

Would you like to be enrolled in Drivers Benefits for free?

     Yes      No

 

Your request may take a few seconds to process - Do Not press the "Submit Request" Button twice!

The Black Car Fund (“The BCF”) is a not-for-profit organization created by New York State to provide workers' compensation insurance to drivers of NY Black Car Services including Uber, Lyft, and the more traditional Black Car bases in the industry. BCF also provides safety and health programs that benefit these for-hire drivers, including the Drivers Health Benefits Program that features the Accident Disability Insurance Plan, $100K Accidental Death Benefit, Personal Accident Insurance, Critical Illness Insurance, Dental Insurance, Vision Coverage, Telemedicine, discounts on Urgent Care and Prescriptions, and more, at no cost to eligible drivers. All the benefits paid for by BCF are funded entirely by the small surcharge that is paid by passengers on each ride. While we encourage all eligible drivers to participate, participation is entirely voluntary, and you are not required to participate. None of the benefits are intended to provide you with any rights of employment or to otherwise affect your status as an independent contractor with respect to BCF or with the dispatch base you are affiliated with. If you are an employee driver, none of the benefits paid for by BCF are sponsored or endorsed by your employer. None of the benefits are intended to be covered by the Employee Retirement Income Security Act (ERISA) or the Patient Protection and Affordable Care Act (“PPACA”). The Black Car Fund reserves the right to revise or terminate these benefits in whole or in part at any time, and for any reason. To learn more about the Drivers Benefits paid for by The Black Car Fund, please visit ny.driversbenefits.org