Booking Form

Rental Agreement Form
This form must be completed in full and signed by the hirer(s) – all driver(s)
Number of Drivers?*
Please enter a number from 1 to 4.
Driver/Hirer 1

Title
Forename(s)*
Surname*
Address*
Street Address Address Line 2 City County Post Code Country
Occupation*
Age at point of hiring
Landline Phone Number
Mobile Phone Number
1. Have you held a full United Kingdom driving licence for the last 24 months?*
- Yes
- No
If no, then you will not be allowed to hire this van
2. Have you ever had their licence revoked or had any restrictions placed upon it?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
3. Have you been convicted of any driving offence or received any caution or fixed penalties during the past 5 years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
4. Have you any prosecution or police enquiry pending?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
5. Have you defective vision or hearing (not corrected by glasses or hearing aid), diabetes or any disease or physical or mental infirmity or fits of any kind?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
6. Have you been involved in an accident or loss in the last three years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
7. Have you had a proposal for motor insurance declined, cancelled or refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
8. Have you had any renewal refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
8. Have you had any renewal refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
9. Have you had any special terms or conditions imposed for Motor insurance?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Details where required
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Driver/Hirer 2

Title
Forename(s)*
Surname*
Address*
Street Address Address Line 2 City County Post Code Country
Occupation*
Age at point of hiring
Landline Phone Number
Mobile Phone Number
1. Have you held a full United Kingdom driving licence for the last 24 months?*
- Yes
- No
If no, then you will not be allowed to hire this van
2. Have you ever had their licence revoked or had any restrictions placed upon it?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
3. Have you been convicted of any driving offence or received any caution or fixed penalties during the past 5 years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
4. Have you any prosecution or police enquiry pending?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
5. Have you defective vision or hearing (not corrected by glasses or hearing aid), diabetes or any disease or physical or mental infirmity or fits of any kind?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
6. Have you been involved in an accident or loss in the last three years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
7. Have you had a proposal for motor insurance declined, cancelled or refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
8. Have you had any renewal refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
9. Have you had any special terms or conditions imposed for Motor insurance?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Details where required
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Driver/Hirer 3

Title
Forename(s)*
Surname*
Address*
Street Address Address Line 2 City County Post Code Country
Occupation*
Age at point of hiring
Landline Phone Number
Mobile Phone Number
1. Have you held a full United Kingdom driving licence for the last 24 months?*
- Yes
- No
If no, then you will not be allowed to hire this van
2. Have you ever had their licence revoked or had any restrictions placed upon it?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
3. Have you been convicted of any driving offence or received any caution or fixed penalties during the past 5 years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
4. Have you any prosecution or police enquiry pending?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
5. Have you defective vision or hearing (not corrected by glasses or hearing aid), diabetes or any disease or physical or mental infirmity or fits of any kind?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
6. Have you been involved in an accident or loss in the last three years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
7. Have you had a proposal for motor insurance declined, cancelled or refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
8. Have you had any renewal refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
9. Have you had any special terms or conditions imposed for Motor insurance?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Details where required
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Driver/Hirer 4

Title
Forename(s)*
Surname*
Address*
Street Address Address Line 2 City County Post Code Country
Occupation*
Age at point of hiring
Landline Phone Number
Mobile Phone Number
1. Have you held a full United Kingdom driving licence for the last 24 months?*
- Yes
- No
If no, then you will not be allowed to hire this van
2. Have you ever had their licence revoked or had any restrictions placed upon it?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
3. Have you been convicted of any driving offence or received any caution or fixed penalties during the past 5 years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
4. Have you any prosecution or police enquiry pending?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
5. Have you defective vision or hearing (not corrected by glasses or hearing aid), diabetes or any disease or physical or mental infirmity or fits of any kind?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
6. Have you been involved in an accident or loss in the last three years?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
7. Have you had a proposal for motor insurance declined, cancelled or refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
8. Have you had any renewal refused?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
9. Have you had any special terms or conditions imposed for Motor insurance?*
- Yes
- No
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Details where required
If “Yes” to any question please provide full details; e.g. convictions(s) endorsement offence code, fine and period of disqualification (if any)
Consent*
I agree to the VDubline Terms & Conditions
Booking Form
13/05/2021
Product Name
Total
£ 0.00

Rental Agreement Form

Driver/Hirer 1

Driver/Hirer 2

Driver/Hirer 3

Driver/Hirer 4

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