Road-safety self-check · Thane

Every ride matters.

A 60-second self-assessment for auto-rickshaw and two-wheeler drivers. Score your safety today, spot what to improve, and drive home smarter.

Who is taking this today?

Your answers go directly to Parivartan NGO. No public sharing.

🛺Auto Driver

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Safety Ambassador Form

Tell us who you are.

Parivartan Social and Education Trust is proud to support National Road & Safety under Project SURAKSHA.

Full Name * Personal Mail ID * Contact No * WhatsApp No * Blood Group * Date of Birth * Driving Licence No *

Gender *

Male Female Prefer not to say

Current Address * Permanent Address Only if different from current address. Your Vehicle No * Example: MH 00 AB 0000. An incorrect vehicle number will invalidate the form.

Do you want to be a Project SURAKSHA Volunteer with us? *

Yes No

Disclaimer

By submitting this form, you confirm that the information provided is true and accurate to the best of your knowledge.
Parivartan Social and Education Trust reserves the right to reject or disqualify any nomination containing false or misleading information.
The organising committee's decision will be final and binding.
Personal data collected will be used only for this campaign and will not be shared with third parties.

✓

Thank you.

Your responses have been recorded and sent to Parivartan NGO. Drive safe out there.

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