This form will take 5 minutes to fill in - make sure you have all relevant information and paperwork ready before starting.

Hirer’s Full Name *

Street Address

City

Country

Postal code

How many years have you resided here? *

Do you plan to move in the next 12 months? *

YES

Phone *

Email *

Date of birth *

Occupation *

Nationality *

JOURNEY DETAILS

Dates of Hire FROM *

Dates of Hire TO *

Reason for Journey (e.g. horseshow, vet trip, own box being repaired etc.) *

Where are you travelling to? *

If hiring for more than one day, please complete the below questions

Please state the address where the horsebox will be parked overnight:

Select all that apply

A third party yard:

Your own premises:

Parking on the road:

LICENCE INFORMATION

The DVLA record motoring convictions electronically, we need a Check Code from the DVLA to check your licence details. To obtain your Check Code, please phone the DVLA on 0300 083 0013, or log in to the DVLA’s Service here www.gov.uk/view-driving-licence

(you’ll need your National Insurance No.)

Driving Licence No. *

DVLA Check-Code *

Date Check Code Obtained *

Country of Issue of Licence *

Period of UK residency in years *

Driving Licence categories held *

Date(s) Driving Test(s) passed *

Have you incurred any motoring convictions or offences in the last FIVE years? *

Yes

Have you ever received a driving ban or disqualification in the last FIVE years? *

Yes

If yes, did these involve drink/drugs/manslaughter/death/dangerous driving or failure to stop?

Yes

Please complete the below table and provide hire firm with evidence of your endorsements/convictions

Date of offence
What happened?
Conviction code
Penalty points
Fine

Picture Of License *

DRIVER MEDICAL CONDITIONS/DISABILITIES

Do you have any medical conditions or disabilities that are notifiable to the DVLA? check here for additional information www.gov.uk/driving-medical-conditions *

Yes

If yes, have you notified the DVLA?

Yes

If yes, have you been issued with a licence?

Yes

Please provide further details below:

DRIVING INCIDENTS HISTORY

Regardless of the circumstances, outcome or fault; have you had any motoring claims or accidents in the last FIVE years? If yes, please complete the below box *

Yes

Date - Describe what happened - Cost - Were you deemed to be at fault?

If other drivers fault, were all costs fully recovered?

Yes

Whilst in charge of any motor vehicle (or if you were the last driver of a vehicle) have you had any vehicle thefts in the last FIVE years? If yes, please complete the below table. *

Yes

Date - Describe what happened - Cost

GENERAL QUESTIONS

How often do you drive a motor vehicle in the UK? *

How long have you been driving this regularly? *

What experience do you have driving a horsebox of the weight you're hiring? *

Have you had insurance refused or declined? *

Yes

Have you ever had insurance cancelled? *

Yes

Has an insurer ever applied special terms, exclusions or restriction to you motor insurance? *

Yes

Do you have any non-motoring convictions? *

Yes

Please use this space to provide any additional information:

IDENTIFICATION PAPERWORK

The following documents must be supplied before you hire.

failure to supply them may result in insurance being invalidated and your hire being cancelled.

We must verify the identity and permanent address of all Hirer/Drivers beyond reasonable doubt.

Two items from the following list are required:

• Bank Statement

• Credit Card Statement

• Mortgage Statement

• Gas / Water / Electricity Bill

• Council Tax Bill / Statement

• HMRC Tax Code Notice

The items supplied must:

• be dated less than 90 days old, other than Council Tax bills which may be dated up to 12 months old

• show the hirer’s name

• show the hirer’s address

Caution - The following documents are NOT acceptable :-

• Letters

• Invoices

• Any document that is illegible

• Insurance Documents

• Any document without a date

• Any document that is cropped and not showing a full page

In order to provide this hire, we will need to retain copies of your documents for 12 months. Failure to supply these documents, will result in you not being able to complete the hire.

Paperwork One *

Paperwork Two *

LICENCE INFORMATION - UK LICENCES ISSUED BY DVLA

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.
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.
I note that full policy terms may be supplied to me on request.
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.

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
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

Please tick here to confirm you have read and understood the above *

Agree

TYPE NAME *

Signiture *

Clear

Date *

If you are using autofill, please make sure there are no yellow error boxes - if there are, you will need to type your answer for it to submit.

Self-Drive Horse Box Hire

FOLLOW US

LINK

LEGAL