Gertie’s Adventures self-drive hire – Booking Form
Chosen camper: ……………………………………………………………………….....................................................
First Driver’s Name: ………………………………………………………………………………………...............................
Address: …………………………………………………………………………………………..............................................
…………….……………………………………………………………………………………………….Postcode: ……………………
Tel (home): ……………………………………….
(mobile): ……………………………………………………
Email: ……………………….......................................................................................................................
Driving license No………………………………………………………………………………………………………………………..
Passed Test when?................................
License issued in which country?..............................
Occupation………………………………………..
Employer……………………………………………………………….
Motoring Accidents in the last 3 years? Yes/No
Dates? …….....................................................
……………………………………………………….
……………………………………………………….
Any physical or mental conditions which may interfere with your ability to drive? Yes/No
(These could be stroke/deafness/heart condition/diabetes/loss of limb/loss of sight in an
eye/epilepsy)
If so, please list:
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
Have you ever been refused motor insurance? Yes/No
If so, please name the company: …………………………………………………………………………………………………
Have you been convicted of any motoring offences in the last 3 years? Yes/No
If so, please list the offence code and date (as indicated on your Driving Licence)
..........................................................................................................................................................
…………………………………………………………………………………………………………………………………………………….
Number of adults:…………………………….
Number of children:……………………………………
Signed: ………………………………………… Date: ………………………..
Please note that answers to these questions may not prohibit you from hiring a vehicle but for
insurance purposes you must declare ANY endorsements, motoring accidents, or physical or
mental conditions.
The insurance excess payable by you is £500.
Please note that we cannot release the campervans without seeing both parts of Driving
Licence and another form of ID – eg a household bill. Please remember to bring these with you.
Gertie’s Adventures self-drive hire – Additional Driver Information
Additional Driver’s Name: ……………………………………………………………………………………….....................
Address (if different to first driver):..………………………………………………..............................................
…………….……………………………………………………………………………………………….Postcode: ……………………
Tel (home): ……………………………………….
(mobile): ……………………………………………………
Email: ……………………….......................................................................................................................
Driving license No………………………………………………………………………………………………………………………..
Passed Test when?................................
License issued in which country?..............................
Occupation………………………………………..
Employer……………………………………………………………….
Motoring Accidents in the last 3 years? Yes/No
Dates? …….....................................................
……………………………………………………….
……………………………………………………….
Any physical or mental conditions which may interfere with your ability to drive? Yes/No
(These could be stroke/deafness/heart condition/diabetes/loss of limb/loss of sight in an
eye/epilepsy)
If so, please list:
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
Have you ever been refused motor insurance? Yes/No
If so, please name the company: …………………………………………………………………………………………………
Have you been convicted of any motoring offences in the last 3 years? Yes/No
If so, please list the offence code and date (as indicated on your Driving Licence)
..........................................................................................................................................................
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
Signed: ………………………………………… Date: ………………………..
Please note that answers to these questions may not prohibit you from hiring a vehicle but for
insurance purposes you must declare ANY endorsements, motoring accidents, or physical or
mental conditions.
The insurance excess payable by you is £500.
Please note that we cannot release the campervans without seeing both parts of Driving
Licence and another form of ID – eg a household bill. Please remember to bring these with you.