Drivers Declaration Form
Drivers must adhere to Road Traffic Legislation and the Highway Code.
Failure to comply could result in disciplinary measures (e.g. using a hand held mobile phone whilst driving or failing to wear a seatbelt).
Name:
Date of Birth:
University Email:
Occupation:
School/Unit/Dept:
Licence – Country of Issue:
Date Passed Test:
Please provide a copy of your driving licence card.
UK licence holders must also follow instructions below to share licence information.
A / Had a proposal declined, a policy cancelled or renewal refused, or been required to pay an increased premium or had special conditions imposed by any Motor Insurer? / YES / NOB / Any physical or mental defect or infirmity or suffered from diabetes, fits or any heart complaint? / YES / NO
C / Been convicted of a motoring offence during the past 5 years or is there any prosecution pending? / YES / NO
D / Been involved in any vehicle accidents or losses regardless of blame during the past 5 years? / YES / NO
E / Been disqualified from driving within the past 11 years? / YES / NO
· If you answer “YES” to any questions, then please give full details on a separate page. This should include the offence code for convictions, the penalty imposed and the circumstances giving rise to the conviction
· All drivers (staff and students) must register every 12 months
· Certain disabilities and medical conditions require to be notified to DVLA.
· If you are required to notify DVLA please provide a copy of their response
· Please contact EHSS if there are any changes to the above conditions during the year.
Signed ...... …………………… Date ………......
Return documentation to: Kenneth Stewart – EHSS - Bute Building - St Andrews KY16 9TS
If you plan to use your own vehicle on University business, please check that you have 'Business Use' cover on your personal insurance policy, as the University cannot cover this activity and it is a criminal offence to drive without insurance.
'Business use' generally means travel which occurs as part of your employment, and would include anything beyond normal 'Commuting'.
Contact your insurer to discuss as interpretations may differ.
Please ensure that when hiring vehicles, the Guidance for Booking Vehicle Hires When on University Business is strictly adhered to. Any queries in relation to this can be directed to Procurement.
UK Drivers: View your driving licence information
The Counterpart licence (D740) is no longer valid as of 8th June 2015.
We now require that you go online and provide licence details – instructions below.
1. You will require:
Driving Licence Number
National Insurance Number
Post Code
2. Use the following link:
https://www.gov.uk/view-driving-licence
3. Screen displays are as follows:
· Start Now
· Enter Details
· View Now
· Share your Licence Information
· Create a Code
· Print or save a driving summary
· Open
4. Print page and forward with declaration form, and plastic card