Automotive – Standard LTD Application Pack FORM

Automotive - Standard LTD Application Pack

Your Details
- Full name*
  First
- Email*
- Mobile*
- Telephone*
- Nationality*
- National Insurance No.*
Date of birth*

Day
Month
Year
Marital status*
Are you male or female?*
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Company Details
Company name*
Company address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
VAT Reg number
Company Reg number*
References
Please provide contact details for at least two referees. If you do not have a phone number or email address for a referee, enter ‘X’ in the corresponding box.
Reference Details*
Name Company Job Title Contact Number Contact Email
- Next of Kin 1
- Name*
- Relationship*
- Address*
  Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
- Telephone*
- Mobile*
- Next of Kin 2
- Name*
- Relationship*
- Address*
  Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
- Telephone*
- Mobile*
Accident Declaration
1. How long have you held your driving licence for?*
2. Do you have any points or endorsements on your licence?*
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?
Have you any unspent convictions? In accordance with the rehabilitation of Offenders Act 1974*
- Yes
- no
If yes, please give details of offences, penalties and dates
Employment date start

Day
Month
Year
Igloo site of work (if known)
Type of work*
Limited Company Bank Details
- Banks or Building Society name
- Bank or Building Society address
  Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
- Sort Code*
- Account number*
- Building Society reference
- Account holders name*
Please upload a copy of your Passport, Birth Certificate or National ID Card:*
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, doc, Max. file size: 100 MB, Max. files: 2.
If you are not a British Citizen, please provide your right to work share code below:
The website to create this is - https://www.gov.uk/view-driving-licence
Please upload copies of the FRONT and BACK of your Driving Licence:*
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 256 MB.
Please provide your DVLA share code below. Please ensure that you type this as it appears on the website, as this is case sensitive.*
Please upload a copy of your proof of National Insurance Number:*
Accepted file types: jpg, jpeg, gif, doc, pdf, png, Max. file size: 100 MB.
Please upload a copy of your proof of address:*
Accepted file types: jpg, jpeg, gif, doc, pdf, png, Max. file size: 100 MB.
Please upload a copy of your Limited Company Certificate of Incorporation:*
Accepted file types: jpg, jpeg, gif, doc, pdf, png, Max. file size: 100 MB.
Please upload a copy of your insurance polices:*
Drop files here or

Max. file size: 256 MB, Max. files: 6.
Please upload a copy of your certificate of VAT registration:
Accepted file types: jpg, jpeg, gif, doc, pdf, png, Max. file size: 100 MB.
TO CONTINUE PLEASE CLICK SUBMIT AND READ THROUGH THE DOCUMENT THEN SIGN AT THE BOTTOM.
CLICK AGREE AND SIGN THIS WILL SEND THE DOCUMENT BACK TO IGLOO