This form must be completed by each person
required to drive the Horsebox

DVLA Check Code

A Check Code is required (under the section Driving History & Licence Information) to check licence details with the DVLA. It is recommended this code be obtained prior to completing this form. 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.)

1 Step 1

Identification

Below are the required items to provide evidence of identity.

• x1 Photocopy / Scan of your Driving Licence (BACK)

• x1 Photocopy / Scan of your Driving Licence (FRONT)

• Proof of address (e.g. Utility Bill /  Bank Statement. Within 90 days of today's date

• x1 Additional Photo ID such as Passport of ID Card

HIRER DETAILS

Please use a valid contact number and email address, we will use this to contact you after submission of this form​

HOW LONG HAVE YOU LIVED AT THIS ADDRESS
JOURNEY DETAILS
Hire Start Time:Start Time
access_time
Timeof appointment
access_time
ACTIVITY 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.)

Your DVLA One Time Use Code:

National Insurance Number:

MOTORING CONVICTIONS IN THE LAST FIVE YEARS

Please tick one box:

I have had NO motoring convictions in the last 5 years

I have had the following motoring convictions in the last 5 years:

Motoring Convictions
Select
Motor Vehicle Accident
Motor Vehicle Fire and Theft claims in last three years
I have had NO Motor Vehicle Accident or Motor Vehicle Fire and Theft claims in the last three years
I have had the following motor convictions in the last 5 years (please insert conviction date & code below) If more than 2 convictions please call us.
MEDICAL CONDITIONS
Motoring Convictions
Select
I have had NO Medical Conditions that would affect my ability to drive safely
I have the following Medical Conditions that may affect my ability to drive safely
OTHER
Do you hold a valid licence for the weight of vehicle being hired?
Have you ever had insurance refused or declined?
Have you ever had insurance cover cancelled?
Has an insurer ever applied special terms to your motor insurance as a result of claims?
Have you any non-motoring convictions?

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

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 affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief.
Terms & Conditions
SignatureI agree to the terms and conditions
(Sign Here)
I agree to the Terms & Conditions

A.H Equine Transport Ltd,​ Stoneycroft, Holmes Chapel Road, Congleton, Cheshire, CW12 4SW

andrew@aheventing.co.uk / 07789 003 001 / 07971 018 474

Company Registration Number: 12075150

keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right
FormCraft - WordPress form builder