Information required and terms agreed when hiring a vehicle from Hillcrest Hire:

Hirer’s Name (in full)……………………………………………………

Address in U.K…………………………………………………………

Permanent Address (if temporary visitor)…………………………..

Date of Birth……………………………………………………………

Precise Occupation……………………………………………………

Business Address…………………………………………………….

Drivers Licence No…………………………………………………….

Date Driving Licence passed & Country of Issue………………….

Collision 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 arising
from the contract to be charged to same.

CardNo. …………………………………………………………………
Security No. ……………………………………………………………

Name on Card: …………………………………………………………

I hearby 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.

 CONVICTIONS: Have you:
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 offence’s)

ii. Had any criminal convictions (or been charged with a criminal offence but not yet tried)
iii. IF YES GIVE NAMES, OFFENCES, DATES, PENALTIES & POINTS

Accidents. Have there 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 full details

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 place.
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 prop’s 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.