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I hereby confirm that there have been no change in my personal circumstances nor driving record since I completed my last hire questionnaire and I can still agree the declaration in my long questionnaire.

First Name of Hirer / Driver:

Email:

Driving Licence Number: 16 digits / capitals

Last Name of Hirer / Driver:

Mobile Number:

Date of the Last Long Form:

Date of this Hire (must be within 3 months of Last Long Form):

DVLA Access Code: 8 digits / case sensitive

Your Signature:

Date of Your Last DVLA Access Code:

Today's Date:

Thanks for submitting!

MILLENS SELF DRIVE HIRE HORSEBOX INSURANCE PROPOSAL SHORT FORM 

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