Driving Licence Confirmation

Driver details

Name*

First Last

Date of birth*

Occupation (including part-time)

Email address*

Telephone number

Driving Licence details

Drving Licence Number*

Type of Driving Licence*

Full
Provisional

Date driving test passed

Date Driving Licence issued*

Date Driving Licence valid to*

Which Authority / Organisation issued your Driving Licence?*

Driving record

1. Have you ever had motor insurance cancelled, refused or renewal refused?*

Yes
No

2. Have you ever been asked to pay an increased premium (other than normal rating increases) or had special conditions imposed?*

Yes
No

3. Have you been convicted of any motor offence (including fixed penalty offences) during the last 5 years?*

Yes
No

4. Have you been reported for any motoring offence or is any prosecution or Police enquiry pending?*

Yes
No

5. Is your driving licence currently under suspension and therefore you are presently disqualified from driving?*

Yes
No

6. Have you had any accident and/or claim during the last 5 years involving any motor vehicle?*

Yes
No

7. Have you any physical or mental defect or infirmity or suffered from diabetes, fits or any heart complaint which has not been notified to DVLA or has resulted in a restricted licence being issued?*

Yes
No

If you have answered YES to any of the above questions, please provide details here:

Declaration

Declaration*

I declare that all the information given above is, to the best of my knowledge and belief, correct and complete in every detail. I also understand that I am prohibited from driving any company vehicle for personal use without prior written permission from one of the Senior Management team.

Data protection*

I understand that by submitting this form I consent to Blair Castle Horse Trials Privacy Policy and them using and keeping the information about me relating to my application and driving.

The information you have provided will be used solely in the recruitment and volunteer administration process and may be retained for a period of twelve months from the date of the event. Any information held will be used solely for internal purposes and will not be disclosed to any third party. For more information please visit www.blairhorsetrials.co.uk/privacy-policy

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Phone

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Driver Declaration

Driver details

Driving Licence details

Driving record

Declaration

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