SELF DRIVE HIRE HORSEBOX INSURANCE
HIRER’S QUESTIONNAIRE

Hirer Information

Journey Details

Driving History & Licence Information

The DVLA only record motoring convictions electronically, we need a Check Code from the DVLA to check your licence details. To obtain the Check Code, please phone the DVLA on 0300 083 0013, or log in to the DVLA's Service on www.gov.uk/view-driving-licence (you'll need your National Insurance No.)

Motoring Convictions in last 5 years

Motor Vehicle Claims, Accidents, Fires and Thefts

Medical Conditions

Additional Information

Please use this space for any other information you would like to declare

Driving Licence and Identification Paperwork: 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 utility (or other) bills that have been issued in your name at your address. We will retain copies of your documents for 12 months, failure to bring these documents with you, will result in you not being able to complete the hire.

Two Utility Bills / Proof of Address (must be less than 90 days old)

Declaration

I declare that :-

  • I have read the above questions and answers that have been completed accurately and fully by me or on my behalf from the information that I have supplied
  • the statements and particulars given above are to the best of my knowledge and belief true and that no information has been withheld that may influence my acceptance as a driver
  • I am not suffering from any loss or loss of use of limb, eye, defective (not corrected) hearing or vision, any heart, diabetic, epileptic condition nor any other infirmity that should be disclosed to the DVLA/DVA or other licencing authority
  • I have not been convicted of any motoring or non-motoring offences other than those stated above
  • I have held a full driving licence for at least two years

I agree that the information supplied :-

  • may be used to check my identity and my suitability to drive
  • may be shared with others to facilitate the arranging of insurance on my behalf and for the purposes and processing insurance claims
  • may be shared with fraud prevention agencies and databases

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 1998, I am entitled, on the payment of a small fee, to receive a copy of the information held about me

I have read and agree to the above declaration and understand that failure to provide accurate information may lead to the cancellation of the booking

Acknowledge *
I have read and agree to the Hire Terms & Conditions *