Rental Agreement

This form must be completed in full and signed for by the hirer(s)

Policy Holder’s Name: M6 Motorhome Hire Ltd

Policy Number: 26/BV/29445024/05

Vehicle Details			YD22 TVU
Make/Model			Ford Roller Team Zefiro 675
Number of seats		5
Date/Time Of Hire	From				To
	Time				Time
Purpose for which vehicle will be used				Recreational

Personal Driver Details	Driver 1 – Driver license number
Surname:
Forename:
Address

			Postcode
Occupation
Age
Telephone number		Mobile

Personal Driver Details	Driver 2 – Driver license number
Surname:
Forename:
Address

			Postcode
Occupation
Age
Telephone number		Mobile

Have you and every person who will drive held a Full United Kingdom Vehicle Driving Licence for the last 2 years

Please Tick

Yes

Have ALL drivers provided their original Driving Licence with current home address and two proof of addresses?

Yes

NOTE: FAILURE TO PROVIDE THIS DOCUMENTATION WILL RESULT IN CANCELLATION OF THE HIRE WITHOUT REFUND

Have you or any person who will drive...

	If ‘YES’ to any question, please provide full details... eg. conviction(s), endorsement(s)offence code(s), fine(s) and period(s) of diqulaification(s) - if any
a. Ever had their license revoked or had any restrictions imposed?	Yes/No
b. Been convicted of any driving offence or received any caution or fixed penalties during the past 5 years?	Yes/No
c. Any prosecution or police enquiry pending?	Yes/No
d. Have defective vision/hearing (not corrected by glasses or hearing aid), diabetes or any condition or physical/mental infirmity or fits of any kind?	Yes/No
e. Been involved in an accident or loss in the last three years?	Yes/No
f. Had a motor insurance proposal declined, cancelled or refused?	Yes/No
g. Had any renewal refused?	Yes/No
h. Had any special terms or conditions imposed for motor insurance?	Yes/No

Material Facts...All material facts must be disclosed. Failure to do so could invalidate the insurance in connection with this hiring. A material fact is one that is likely to influence an insurer in the assessment and acceptance of the proposal eg. a young or inexperienced driver or any offence (including non motor related offences such as fraud, robbery,theft or handling stolen goods) or, prosecutions pending, or infirmities of any driver. Material facts MUST be disclosed in relation to yourself and ALL other persons to be insured. If you are in any doubt as to whether a fact is material, then it should be disclosed to M6 Motorhome Hire Ltd. It is an offence under the Road Traffic Acts to make any false statement or withhold any material information for the purpose of obtaining a certificate of motor insurance. If any changes in circumstances arise during the period of insurance cover, please contact M6 Motorhome Hire Ltd immediately with full details. A specimen copy of the policy wording is available on request

Declaration... Please tick the boxes below if your in Agreement

	I/we understand the contents of this completed application and I/we declare that the information given is, to the best of my/our knowledge and belief, correct and complete. I/we agree that the statements within this application shall form the basis of the contract between M6 Motorhome Hire and myself/ourselves
	I/we understand that my/our information may also be disclosed to regulatory bodies for the purposes of monitoring and/or enforcing the insurer’s compliance with any regulatory rules/codes
	I/we undertake that the vehicle will NOT be used for the carriage of passengers for hire or reward
	I/we further undertake that ONLY drivers disclosed in this declaration will drive and that to my/our knowledge have not been refused any motor vehicle insurance
	I/we understand that this insurance terminates at the expiry of the period of hire stated
	I/we further agree to be bound by the terms and conditions of the insurance which I have had the opportunity to see and read

Hirer 1	Signature: …...................................Date: …..............
Hirer 2	Signature …....................................Date: …..............
Offical Use only:		Driving license number

Please note that the vehicle MUST be returned undamaged with the same amount of fuel supplied at hand over empty of waste water, with an empty toilet cassette and the interior clean and in the same condition as when you took delivery of the vehicle at commencement of hire - otherwise charges may be applied as outlined in the T&Cs

In signing this agreement you have read and accept the terms and conditions of the self drive hire agreement

M6 Motorhome Hire Ltd

RENTAL AGREEMENT