Information required and terms agreed when hiring a vehicle from Hillcrest
Address (if temporary visitor)
Licence passed & Country of Issue
damage of the first £500 is to be paid by the hirer on return of any
damaged vehicle (tyre damage, dents, scratches, interior damage etc).
I hearby give authorisation with my signature below for any charges
from the contract to be charged to same.
declare that: The car will only be used for social domestic pleasure and in
conjunction with my business and will not be used for the
carriage of passengers for hire or reward. I am not under 21 or over 75
years of age.
I. Had any
motoring convictions in the last 5 years (7 years if drink or drug related)
or are there any prosecutions pending or police enquiries
outstanding (including fixed penalty offences)
ii. Had any
criminal convictions (or been charged with a criminal offence but not yet
iii. IF YES GIVE NAMES, OFFENCES, DATES, PENALTIES & POINTS
been any accidents thefts or losses (whether covered by insurance or not and
regardless of blame) during the last 3 years in connection with any
vehicle owned, driven or in the charge of you?
If YES give details of year Total cost and settled claims Number
Total number of accidents, thefts or losses. Outstanding losses
and claims Estimated Cost
Have you any physical or mental defect, impairment of sight, hearing,
diabetic or epileptic or other complaint?
If YES give
I hold a
current driving licence and have had 12 months or more experience under a
licence other than a provisional licence and have resided in the United
Kingdom or Republic of Ireland for a period of not less than 3 years.
I hold a current foreign or international licence, other than a provisional
licence, am aged over 25 years, have had 12 months or more driving
experience and am a temporary visitor to this country.
I have not had any motor insurance proposal declined nor any motor insurance
cancelled or special terms imposed.
The hirer shall not use the vehicle:
(a) knowingly for any unlawful purpose
(b) after the expiry of the period of hire stated, if not the prop. will
immediately start proceedings against the hirer.
(c) outside the united Kingdom without written approval.
Hirer will return the vehicle to the prop on the date shown above or earlier
as demanded by the prop. together with all tyres, tools and accessories in
same condition as received.
The hirer shall not use the vehicle if any damage or fault arises to make
the vehicle unroadworthy or liable to cause danger to any person or property
until such damage or fault has been repaired or corrected, in the event of
such fault arising the hirer must notify the prop immediately.
The hirer shall be liable as owner in respect of:
(a) any of the following offences which may be committed with respect of
that vehicle when it is stationary and when a fixed penalty notice is issued
being on a road during the hours of darkness without the lights or
reflectors required by law; waiting or being left or parked or being loaded
or unloaded; being used or kept on a public road without displaying vehicle
excise licence; and non-payment of the charges made at a street parking
The hirer shall defend indemnity and hold harmless the proposal from and
against any and all losses, liabilities, damages, injuries, claims, demands,
costs and expenses arising out of connection with possession or use of the
vehicle during the rental terms including but not limited to any and all
claims of or liabilities to third parties arising out of the abandonment,
conversion, secretion, concealment or unauthorised disposal of the vehicle
by the hirer or by the confiscation of the vehicle by any governmental
authority for illegal or improper use of said vehicle.
The hirer shall immediately report any accident to the prop every process
pleading or notice or paper of any kind received by the hirer or any driver
of the vehicle relating to any claim Suit or proceeding connected with any
accident or event involving the vehicle neither hirer nor any driver of the
vehicle shall aid or abet the assertion of any such claim Suit or
proceedings and Shall co-operate fully with the prop and its insurers in
investigating and defending the same.
The prop shall not be liable for loss or damage for any property of the
hirer or any other person which may have been in the vehicle either before
or after its return to the prop whether or not relating to the negligence of
prop. The hirer shall assume all risk of all such loss or damages, waive all
claims therefore against the prop and defend, indemnity and hold the prop
harmless from all claims arising out of such loss or damage.
The prop may demand the return of the vehicle at any time and if in the
props reasonable judgement such demand might not be complied with the prop
may repossess the vehicle and terminate this rental agreement without any
liability for any loss or damage which hirer may sustain as a result of such
demand, termination or repossession. In the event of default in the payment
of any amount due to prop under terms of this agreement and if this account
is placed in the hands of any agency or solicitor for collection or legal
action the hirer agrees to pay in addition the amount due hereunder all
costs of collection including agency and solicitors fees and court costs.
The hirer agrees that any misstatement herein containing or any breach of
any provision of agreement will authorise the prop forthwith to repossess
the rental vehicle by use of any lawful means.
The hirer is responsible for theft of the rental vehicle unless keys are
removed and doors locked. The hirer shall drive and use the vehicle in a
skilful and careful manner at all times.
I hereby warrant the truth of the particulars given in this proposal and I
declare that I have withheld no information whatever which might tend in any
way to increase the risk of The Insurer Limited, or influence the acceptance
of this proposal. I agree that this Proposal shall be the basis of the
Contract between me and the Insurers Limited and I further agree to be bound
by the terms and conditions of the Policy, which I have had the opportunity
to read. I further declare that I am not among the excluded persons
enumerated above. I have read the above and agree to the terms and
conditions there in.