What is their title?

What is their first name?

What is their surname?

What is their date of birth?

Have they been permanently resident in the UK since birth?

Yes No

When did they become a resident?

What is their relationship with you?

What is their marital status?

Married Single Civil partnered Divorced Widowed Common Law

What's their employment status?

What is their main job?

What industry do they work in?

What educational establishment do they work in?

Student

What type of full time student are they?

What type of student are they?

What type of licence do they have?

When did they get their licence?

Do they have any medical conditions or disabilities that the DVLA needs to be notified of?

Yes No

Does the DVLA know about these medical conditions?

DVLA Aware DVLA Unaware

Do they drive any other vehicles?

On any motoring policies they've held in the last 5 years, have there been any accidents, thefts or losses? Please include all incidents even if they or the named driver on that policy weren't at fault and didn't have to make a claim.

Yes No

Have they committed any driving offences or had any fixed penalty notices in the last 5 years? Please include any that are still pending.

Yes No