A form must be completed by each hirer/drivers, other than drivers declared to us as non-hiring drivers.
Hirer's Name *
Post Code *
Please leave this field empty.
How long have you lived at this address? *
Home Telephone *
Mobile Telephone *
Work Telephone *
Date of Birth *
Period of hire *
Reason of journey *
Please indicate areas of use *
Country of Issue of Licence *
Driving Licence Categories Held *
Date driving test passed *
Driving Licence Number *
The DVLA only record motoring convictions electronically, we need a Check Code from the DVLA to check you licence details. To obtain the Check Code, please phone the DVLA on 0300 083 0013, or log in to the DVLA's Service on https://www.gov.uk/view-driving-licence (you will need your National Insurance No)
Do you have any motoring convictions?
Date of Office
Date of Conviction
No of points
Did your insurers recover ALL claim costs from the third party?
Do you have any medical conditions?
Has this condition been declared to the DVLA?
How often do you drive a motor vehicle in the UK?
How long have you been driving this regularly?
Have you ever had insurance refused or declined?
Have you ever had insurance cover cancelled?
Has an insurer every applied special terms to your motor insurance as a result of claims?
Have you any non-motoring convictions?
Please provide details of any non-motoring convictions
Please provide any other information you would like to declare
Please indicate what style of driving licence you have been issued with and bring all parts with you on the day of hire. Please also bring two utility (or other) bills that have been issued in your name at your address, passport or other photo ID. We will retain copies of your documents for 12 months, failure to bring these documents with you, will results in you not being able to complete the hire.
Style of driving licence
I declare that:-
I agree that the information supplied :-
I further agree to be bound by the terms and conditions of the insurance which I have seen and read or have had the opportunity to see and read. I understand that subject to the provisions of the Data Protection Act 1988, I am entitled, on the payment of a small fee, to receive a copy of the information held about me.
I confirm the above details are correct