EmailMeForm
Your name
*
First
Last
Date form completed
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DD
/
YYYY
Vehicle Registration
*
Enter your registration number
Odometer Miles
Enter the reading exactly as shown
Which scheme are you in
Please select
I am a member of the company car scheme
I am a member of the vehicle allowance scheme
Choose an insurance option that applies to you
I am a member of the company car scheme and the vehicle is insured for private and business use by Bravilor Limited.
I provide my own vehicle and I confirm my insurance covers me for business use as an employee of Bravilor Limited.
Use this area to report on any damage to your vehicle. Any damage including stone chips will result in charges to the organisation by the lease company.
Enter description of damage using position codes for locations
Attach a photo if required
Your tyres
For safety reasons it is recommended that you replace your tyres before the legal limit is reached. Many vehicle manufacturers recommend replacing at 3 millimetres. At 1.6 millimetres in wet weather it takes an extra two car lengths (8 metres) to stop at 50 mph than if your tread was 3 millimetres.
Legal wear Above 3 mm
Replace soon Near 3 mm tread)
Replace now Equal or less 3mm
Front Left
Front Right
Rear Left
Rear Right
Spare
Additional comments
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For supporting documents
Legal compliance
I understand that an accident can affect my life, and the lives of others around me and my vehicle.
I agree to follow all UK laws and company procedures while operating a Company vehicle.
I hereby agree to abide by the following driving guidelines:
• I will use the safety belt (seat belt) whenever operating a company vehicle, or whenever driving for company business.
• I will operate only those vehicles I am trained and licensed to operate. I will operate only those vehicles I am approved by my supervisor to operate.
• I will always check vehicle for defects and adjust safety devices such as seat belts and mirrors before operating.
• I will never operate any vehicle when impaired by fatigue, medication, drugs, or alcohol or vehicles that I do not feel capable of handling in both normal and emergency situations.
• I will obey all laws, rules, regulations, and company policies. Use common sense and adjust speed and operation to conditions and possible hazards or dangers.
• I will operate vehicles in a courteous manner, irrespective of behavior of others. I will drive defensively anticipating possible dangers or hazards.
Legal compliance
I confirm I have read and understood the legal statement above.