Blank Drivers Declaration Form
Introduction
Any individual (staff or temp) driving a vehicle on company business is required to complete the sections of
this form that apply to them. CfBT is required by law and our insurers to ensure those driving on behalf of
the Trust are fit and legally permitted to do so.
Where a privately owned vehicle is being driven, CfBT are required to check its roadworthiness and that it
is appropriately insured.
The information within this form should be stored electronically by the person in charge of personnel files
and information. Please ensure you provide the additional documents requested, as part of your form
submission.
Driver category
Depending on the category of driver you are will dictate which sections of this form are required to be
completed.
Driver category
Select from drop down
1 Driver
Driver name
Date of birth
Contact
Email
Type of licence held
full
Date passed test
Country in which
licence was issued
Have you had any
convictions within the
last five years?
Yes
If yes, please
provide details
Date
Conviction
Points
Fine
DD/MM/YY
DD/MM/YY
Have you had any
accidents within the
last five years?
No
If yes, please
provide details
Date
Detail
Repair
DD/MM/YY
DD/MM/YY
Do you suffer from any condition which
could affect your ability to drive?
No
If yes, please
provide details
Do you have any official medical
endorsements on your licence?
No
If yes, please
provide details
Have you ever been declined motor
insurance or had a policy cancelled?
No
If yes, please
provide details
Do you wear glasses for driving?
No
Have you had an eyesight test within
the last two years?
No
I have attached a copy of my driving
licence to this declaration
Property Services
Driver declaration form
Employees can receive free eye tests,
please contact your site Responsible
Person for more information.
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Blank Drivers Declaration Form PDF
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