Section One

Hire vehicle details

Pick up date/time (from 2pm on day of hire) *

Date

Time

Return time/date. Note that motorhomes must be returned by 10AM. *

Date

Time

Section Two

Full name *

First

Last

Email *

Mobile Tel Number *

Alternative Contact Tel Number *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

European insurance cover required (please contact us if you would like to arrange European cover) *

Yes
No

Date of birth (dd/mm/yyyy) *

National Insurance Number *

This is needed by the DVLA for driving license checks

Driving license number *

Do you hold a current UK license?

If your driving license isn't a UK license, please tell us the country which issued it

Date you passed your driving test (dd/mm/yyyy) *

Date your license is valid from (row B on the rear of the UK license) (dd/mm/yyyy) *

Date your driving license expires (4b on the front of a UK license) (dd/mm/yyyy) *

Have you been convicted of any drivings offence or received any caution or fixed penalties during the past 5 years? *

Yes
No

Details of any driving convictions, cautions or fixed penalties received over the past 5 year

Do you have any driving prosecutions or police enquiries pending? *

Yes
No

Details of prosecutions or police enquiries pending

Have you had motor insurance declined, cancelled or refused over the past 5 years? *

Yes
No

Details of motor insurance declined, cancelled or refused

Have you had any special terms or conditions imposed for motor insurance? *

Yes
No

Details of special terms of conditions imposed

How many endorsements (points) have you had in the past three years *

Offence code 1 and date the offence was committed

Offence code 2 and date the offence was committed

Offence code 3 and date the offence was committed (copy)

How many vehicle accidents have you had in the past 3 years? *

Declaration (you will be asked to sign this when you pick the vehicle up)

You agree to the following charges if applicable *

Should the hire vehicle be returned late (after the agreed time stated on the rental agreement): A late fee of £50 per hour will be charged
Any parking/other fines and/or penalty charges incurred during the hire period by the hirer(s) : Incurred fees will be charged PLUS an administration fee of £25 per fine/charge
Should the vehicle not be returned with the interior in a clean condition: A valeting/upholstery cleaning fee of £50 will be charged
If the vehicle is returned with less fuel than at the point of handover, we will charge the cost of refuelling PLUS an administration fee of £25
A fee of £50 will be charged if, on return, the vehicle toilet cassette has not been emptied.
Cost of any damage to vehicle or third party property - subject to the insurance
Any cost(s) resulting from any breach by the hirer(s) of this agreement
Daily rental cost(s) whilst the vehicle is off fleet - eg. for accident repairs etc (demurrage)
Any cost(s) over and above the security deposit amount should that amount be exceeded

Please confirm the following by checking the relevant boxes). You will be asked to sign this form when you pick up your motorhome rental. (copy) *

I understand the contents of this completed application and I declare that the information given is, to the best of my knowledge and belief, correct and complete.
I agree that the statements within this application shall form the basis of the contract between Far and Away Motorhomes and myself.
I understand that my 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 undertake that the vehicle will NOT be used for the carriage of passengers for reward or offered for hire to anyone else.
I undertake that ONLY drivers disclosed in this declaration will drive and that to my knowledge have not been refused any motor vehicle insurance
I understand that this insurance terminates at the expiry of the period of hire stated.
I agree to be bound by the terms and conditions of the insurance which I have had the opportunity to see and read.

By completing and submitting this form, you are agreeing to be bound by it. 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 Far and Away Motorhomes. 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 Far and Away Motorhomes immediately with full details. A specimen copy of the policy wording is available on request It is a criminal offence to make a false statement or withhold material information for the purpose of hiring a motor vehicle or obtaining insurance. By pressing "Submit" you confirm you have read and accept our Terms & Conditions of hire Please wait a few seconds for your confirmation that this form has been processed.

Driver 1 details

Please complete this form with details of the primary driver

Section One

Section Two

Declaration (you will be asked to sign this when you pick the vehicle up)