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Driver
What is their title?
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Mr
Mrs
Ms
Mx
Miss
Doctor
Professor
Reverend
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What is their first name?
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What is their surname?
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What is their date of birth?
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Have they been permanently resident in the UK since birth?
Yes
No
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When did they become a resident?
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1921
What is their relationship with you?
- Please Select -
Spouse
Parent
Child
Brother or sister
Common law partner
Civil partner
Unrelated
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What is their marital status?
Married
Single
Civil partnered
Divorced
Widowed
Common Law
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What's their employment status?
- Please Select -
Employed
Self employed
Full time education
Retired
Household duties
Unemployed
Not employed due to illness/disability
Voluntary work
Financially assisted
Independent means
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What is their main job?
Please enter a valid main job.
What industry do they work in?
What educational establishment do they work in?
- Please Select -
Primary school
Secondary school
Independent school
Academy
Special school
University or college
Other
Please enter an educational establishment
Student
What type of full time student are they?
- Please Select -
University Student
Further Education College Student
6th Form/School Student
What type of student are they?
- Please Select -
Student - Living At Home
Student - Living Away
Student Teacher - Living At Home
Student Teacher - Living Away
Medical Student - Living At Home
Medical Student - Living Away
Mature Student - Living At Home
Mature Student - Living Away
Student Nurse - Living At Home
Student Nurse - Living Away
Post Graduate Student - Living At Home
Post Graduate Student - Living Away
Undergraduate Student - Living At Home
Undergraduate Student - Living Away
What type of licence do they have?
- Please Select -
Full UK
Provisional UK licence
EU licence
European non EU
International
Medical Restricted (Full) less than 3 years
Medical Restricted (Full) 3 years or more
This field is required
When did they get their licence?
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This field is required
Do they have any medical conditions or disabilities that the DVLA needs to be notified of?
Yes
No
This field is required
Does the DVLA know about these medical conditions?
DVLA Aware
DVLA Unaware
Does the DVLA know about these medical conditions?
Do they drive any other vehicles?
They have access to other vehicles for
Named driver on another vehicle
No access to any other vehicle
Own other vehicle
This field is required
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
This field is required
Add new claim
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
This field is required
Add new offence