Fleet Insurance Questionnaire

Full Name:

Date of Birth:

Type of Licence:

How long have you held the above licence? (years and months)

List all motoring convictions received in the last 5 years.

List any medical conditions the DVLA need to be informed about.

Free Text

South Western Group Ltd. will carry out an online driving licence validation. Please supply the following details below.

Driving Licence Number:

National Insurance number:

Opt-In

By checking, I consent that South Western Group Ltd. may store the above information in digital format and only share for reasons directly related to my employment with South Western Group Ltd.