Split Logistics Hire Form

Booking Ref: Band/Artist/Production, or Person who made the booking

Name

First NameLast Name

Email

example@example.com

Phone Number

Address

Street Address

Street Address Line 2

Citycounty

post code

Driving License Number

Date Of Expiry

Date UK test passed

Have you been involved in an accident or had any insurance claims in the last 5 years

Has you driving license been endorsed in the last 5 years or do you have any pending endorsements?

Do you have any physical defect or infermity?

If you have answered yes to any of the above questions, please give details below.

Please add an image of the front of your driving license

Please add an image of the back of your driving license

Please add your DVLA Driving Summary

To generate your DVLA driving summary please follow this link https://www.gov.uk/view-driving-licence Once you have generated your DVLA check code, click on the link below the code (print or save your driving summary)

I hereby warrant the truth of the above statements and I declare that I have not withheld any information whatsoever which might tend in any way to increase the risk of the insurers
or influence the acceptance of this proposal. I agree that this proposal shall be the basis of the contract between me and the insurers and I further agree to be bound by the
terms and conditions and exception of the policy, which I have had the opportunity to see and read. I further declare that my occupation and personal details and driving record do not
render me ineligible to hire.
ACCEPTANCE OF TERMS AND CONDITIONS OF HIRE: I have read the terms and conditions attached and agree to be bound by them. I understand the vehicles tyres are not
included on the insurance. I also understand that windscreens are not covered on the insurance under any circumstances. I am responsible for all parking, speeding and fixed penalty
charges. Any late payments for such parking, speeding and fixed penalty charges will incur an administration fee. I/We will not use this vehicle for hire or reward.

Signature