PO Box 145
Bulwer Avenue Office
Bulwer Avenue
St Sampson
GY2 4LR
Tel: 01481 243400
www.gov.gg
DECLARATION OF
MISLAID/DESTROYED/DEFACED
CERTIFICATE OF
RETENTION/ENTITLEMENT
This application form is issued by the Committee for the Environment & Infrastructure in accordance with
the Vehicular Traffic Ordinance, 1932 and Registration Marks (Sale & Retention) Ordinance, 1997
1. Your details
Title:
Mr
Surname:
PLEASE USE BLOCK CAPITALS
Mrs
Miss
Ms
Other
(specify)
Forenames:
Date of birth:
Address:
Post Code:
Tel. Number:
Mobile:
2. Statement
I have:
Mislaid
(tick where appropriate)
Destroyed
Damaged
My Certificate of retention/entitlement for registration number:
I understand that there is a fee of £42.00 payable for a duplicate document
3. Declaration
I hereby declare that my original certificate has been mislaid, destroyed or damaged
(as indicated in Section 2) and that the original is now deemed null and void and
should it be found, I must surrender it to the Driver & Vehicle Licensing without
delay.
Signature:
Date: