Additional Driver Form - Ravenhall Group

Policy Holder Name*

First Name / Company Name Last

Drivers Name*

First Last

Occupation*

Marital Status*

Employer's Business*

Date Of Birth*

Relationship to Policyholder*

Date of Addition to Policy*

Will They Use The Vehicle Other Than For Social, Domestic & Pleasure Purposes?*

Please Give Details of use*

Do They Hold a UK Full or Provisional Driving Licence?*

Please Give The Length Of Their Driving Experience*

Was Driving Experience Gained Outside Of The UK?

Please Indicate Where Driving Experience Was Gained*

Have You Had Any Experience Driving This Type of Vehicle?*

Have They Ever Been Convicted Of A Motoring Offence Or Are There Any Pending Prosecutions?*

Please Specify Motoring Offence/Prosecutions*

Are They Now or Have They Ever Been Insured in Respect of Any Motor Vehicle?*

Please Give The Name of Insurers

Please Give The Policy Number

Has Any Insurer Ever Cancelled or Declined Insurance or Continuance Thereof or Imposed Special Terms?*

Please Specify Reason of Cancelled, Declined or Imposed Special Terms*

Give Details of All Accidents, Claims or Losses Involving Any Vehicle Driven By Them And Occurring In The Past 5 Years*