Removal Agreement

• By signing below, the Participant confirms they are eligible for removal of the interlock on the previously selected “Removal Date.”

• The Participant acknowledges that any outstanding fees are due and payable on or before the Removal Date.

• The Participant acknowledges that there are no outstanding disqualifications, suspensions, or unsatisfactory performance issues that would extend the interlock program beyond the Removal Date.

• The Participant releases the Service Provider and Authorized Service Agent, including their employees, officers, and directors, from any and all actions, causes of action, claims, and demands related to the removal of the interlock.

Participants Acknowledgement

The removal of your interlock is your decision. If you have a removal letter please upload it. If you do not have a removal letter your device shall be removed as requested however noting and acknowledging the following conditions:

• You cannot legally drive without an interlock until you receive a completion notice. Removing the device will be at your own risk.

• Removing the device prematurely, and needing to re-install due to non-program completion may incur fees for the re-installation and further removal when required.

• Any days that the device is not in your vehicle, your program is on HOLD, and days toward your program will not be counted.

• If you drive with an interlock condition on your licence, without the interlock in your car, you risk a significant fine and may also need to re-start the program. 

Third Party Acknowledgement

If you are not an Authorised Representative:

• You acknowledge that your relationship to the Participant does not grant you authority to alter, suspend, or cancel any alcohol interlock licence condition.

• You understand that the Participant remains solely responsible for complying with all interlock program requirements and driver licence conditions imposed by the relevant driver licensing authority.

• You acknowledge that this request does not constitute approval, completion, or variation of the Participant’s interlock condition.

Legal Authority Acknowledgement

By submitting this request, I acknowledge and declare that:

1. I am acting in accordance with my legal authority to request the removal of the alcohol interlock device on behalf of the Participant.

2. I have provided verified documentary evidence of my authority (e.g., court order, Power of Attorney, legal representation letter).

3. I understand that the Participant remains legally responsible for complying with all interlock licence conditions and program requirements imposed by the relevant driver licensing authority.

4. I understand that removal of the interlock device does not constitute completion, approval, or cancellation of the Participant’s interlock program.

5. I understand that any period during which the device is not installed may place the Participant’s program on HOLD, and days will not count toward program completion.

6. I acknowledge that re-installation may be required in the future and that associated fees may apply.

7. I declare that the information provided in this request is true, accurate, and complete, and I understand that providing false or misleading information may result in refusal of the request or referral to the relevant driver licensing authority.

• By signing below, the Participant terminates the Service Agreement entered into with the Service Provider pursuant to Paragraph 8 of its terms and conditions.

• The Participant acknowledges that this constitutes early termination of the Service Agreement and that the Removal Fee and Early Termination Fee are due and payable.

• The Participant acknowledges that early termination will be reported to the Administering Authority and may result in loss of driving privileges.

• The Participant releases the Service Provider and Authorized Service Agent, including their employees, officers, and directors, from any and all actions, causes of action, claims, and demands relating to such early termination.
  

Privacy Statement

Persuant to the Service Agreement, Affordable Interlock Systems (AIS) collects your personal information to provide you services. Information will be used by AIS and where relevant, may be shared with the applicable jurisdiction as a requirement by law. Your personal information will not be used for a further purpose or disclosed to a third party without consent unless authorised to required to by law. Further information about our privacy handling practices can be accessed here

AIS-NET-O-020

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