HIRE DOCUMENTATION Important information please read First Name Last Name Date of Birth Email Address Phone Hire Start Date Street Address Street Address Line 2 City Region/State/Province Postal / Zip code Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Costa Rica Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Macedonia Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe How long have you lived at this address? Tick this box if you plan to move address in the next 12 months Occupation Role/Position Your Industry Reason for hire and where you are travelling to If the horsebox is with you overnight, where will it be parked? Please supply address. DVLA Check Code (log in to the DVLA's Service at www.gov.uk/view-driving-licence (you'll need your N.I. number) DVLA License Summary in PDF (you can download this from the same place you obtain the DVLA Check Code) Driving License Number Passport or other photo ID Driving License (front) Driving License (back) Proof of Address 1 (less than 90 days old) Proof of Address 2 (less than 90 days old) License Country of Issue Period of UK residency (years) Driving Test Passed (Year) Do you have any medical conditions or disabilities that are notifiable to the DVLA? Check via https://www.gov.uk/driving-medical-conditions * Yes No If yes, have you notified the DVLA? Yes No N/A If yes, have you been issued with a license? Yes No N/A If yes to any of the above questions, please provide details: Regardless of the circumstances, have you had any motoring claims or accidents in the last 3 years? If yes, please provide details. If no, please type N/A Whilst in charge of any motor vehicle, have you had any vehicle thefts in the last 3 years? If yes, please provide details. If no, please type N/A How often do you drive a motor vehicle in the UK? How long have you been driving this regularly? What experience do you have of driving a horsebox of the weight you are hiring? Have you ever had insurance refused or declined? * Yes No Have you ever had insurance cancelled? * Yes No Has an insurer ever applied special terms, exclusions or restrictions to your motor insurance? * Yes No Have you any non-motoring or criminal convictions? * Yes No Please use this space to provide any additional info I accept Nags T&C Send