Name:  

Position:   

For insurance purposes and to ensure that you are covered should an accident involving yourself occur you must complete the following declaration. This document will be re-issued, and you will need to complete this every quarter when we update your online DVLA check with you.

If you answer yes to any of the below questions you must provide further details and we reserve the right to discuss this further with you as it may have an impact on your suitability for the position.

1)How long have you held your driving license?   

2)Do you have any points or endorsements on your license? 

a) If yes, how many?  

b) What are these for?  

3)Have you been involved in any accidents in the past 4 years?  

If you answered yes to question 3, please provide full details below, including, dates, who was at fault and was there an insurance claim made?