SU Driver Declaration Form
Bristol Student’s Union and our insurers require that everyone who drives for clubs/societies/community & volunteering should complete this declaration
Full name *
Your answer
Your Club/Society/student group *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Year of Graduation
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Driving License No. *
Your answer
Date Passed Test *
MM
/
DD
/
YYYY
If you answer 'No' to any of the next three questions you must complete a "Non-standard Additional Driver Questionnaire" insurance form
Are you over 21 years of age? *
Do you hold a UK driving license? *
Have you held a UK Driving Licence for two or more years? *
If you answer 'Yes' to any of the next four questions you must complete a "Non-standard Additional Driver Questionnaire" insurance form
Have you been involved in any motor accidents during the past 5 years? *
Have you ever been convicted of any motoring offences or are there any prosecution pending? *
Do you suffer from diabetes, epilepsy, defective hearing or vision, heart condition, or any other physical or mental disability, infirmity or disease? *
Have you ever had any motor vehicle insurance you hold or have held, declined, cancelled or refused at normal terms? *
Declaration
Please read carefully before submitting
I hereby warrant and declare that the above statements and particulars are true and there is no material fact which should be disclosed. I agree that the copy of the license sent through is genuine and has not been tampered with. I agree to advise immediately any changes in particulars. I understand that this data will only be used for the purposes of motor insurance and will be held in accordance with the Data Protection Act, 1998. I agree to abide by the Bristol SU rules and those of the hire company regarding the use of hire vehicles. I understand that I will be liable for any uninsured losses that occur whilst driving. *
Required
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