1. I declare that the answers given on this form are true to the best of my knowledge and belief and that no information has been withheld. I also agree that if another person has given any information on this form, he or she acted as my agent for this purpose. I hereby consent to any information you may have about me being processed in accordance with current data protection legislation.
2. I note that at my request a copy of this completed form can be supplied to me, provided that the request is made within a period of three months after this form’s completion.
3. I note that full policy terms may be supplied to me on request.
4. I undertake that the hired vehicle(s) will only be driven by persons declared to the hire firm and will not be driven by :-
a. Persons under the permitted lower age limit as advised to me by the hire firm; nor persons over 75 years of age,
b. Persons that have held a UK or EU driving licence for less than two years,
c. Persons that have less than two years recent driving experience of a motor vehicle in the United Kingdom,
d. Persons that have been convicted of an offence in connection with the driving of a motor vehicle or motorcycle and/or have had their driving licence suspended or endorsed with more than 6 penalty points within 5 years of the date of them driving; (Parking offences and “Spent” convictions, covered by the Rehabilitation of Offenders Act 1974, may be disregarded).
e. Persons with a disability or medical condition that must be notified to the DVLA, unless the DVLA have been notified and a current driving licence valid for the vehicle being driven is held
f. Persons that have had an insurance declined and/or renewal refused and/or any other special terms imposed and/or have had an insurance policy cancelled by an insurer,
g. Persons who have been involved in more than one fault, or two non-fault motor accidents/thefts/claims in the last three years,
h. Persons engaged in any of the following occupations or professions:-
i. Professional entertainment or theatrics
ii. Undergraduates or students age under 25 years
iii. Foreign Services personnel born outside of the United Kingdom
If part 4 cannot be complied with the person may not drive and Insurance will be invalidated – upon disclosure advance referral may result in Insurers quoting special terms in order to grant cover – in all cases Insurers reserve the right to decline cover.
5. I agree that Insurers will only provide cover for hirers that have:-
• fully completed and signed a Millins hirer proposal form immediately prior to the hire, or
• fully completed and signed a Millins hirer proposal form within 12 months of the date of the hire AND completed a repeat hire slip form immediately prior to the hire
6. I agree that Insurers will only provide cover for :-
• Social, domestic and pleasure purposes and the business of the driver or hirer (excluding the carriage of passengers for hire and reward).
• Carriage of Goods for Hire & Reward is excluded – unless the hire firm have authorised such use AND the Certificate of Insurance permits so. The only type of goods that may be carried for Hire & Reward are Horses
• Only horses and ancillary equestrian equipment may be carried
• Carriage of goods of an explosive, dangerous or hazardous nature is excluded
• Private Hire is excluded