🚗Vehicle Declaration Form

This form is required for all BrightPath Neuro employees who use their personal vehicle for work-related purposes, including travel to appointments, visits, or between sites. Completing this form helps us ensure that all staff vehicles are safe, roadworthy, and compliant with legal requirements.

By completing this declaration, you confirm that:

Your vehicle has a valid MOT certificate (if applicable)
Your vehicle is taxed and insured for business use
You hold a valid UK driving licence appropriate for the vehicle you are driving
Your vehicle is maintained in a roadworthy condition in line with UK regulations

Please note: If you do not drive or do not use a vehicle for work purposes, you do not need to complete this form.

Thank you for helping us uphold safety and legal compliance across all services.

👤Employee Details

Full Name

Date of Submission

Job Title/Role

Work Location

(On-site/Remote/Both)

🚘Driver and Vehicle Details

Do you drive a personal vehicle for work purposes?

Type of vehicle used (e.g., car, motorcycle, van)

Vehicle registration number

Make and model

Colour

Driving licence number

Licence valid until

Are you legally licensed to drive this vehicle in the UK?

Do you have any current driving endorsements?

If yes, please specify

🪪Vehicle Safety and Compliance Checklist

Please confirm that the following are up to date and valid (please tick all that apply)

MOT Certificate

Vehicle Tax

Insurance (including business use)

Vehicle is maintained in a safe and roadworthy condition

✍️Declaration

I declare that the information provided above is accurate and up to date. I understand that I must inform BrightPath Neuro immediately of any changes to my driving status, vehicle insurance, or roadworthiness. I also confirm that I will not use my personal vehicle for work purposes unless it meets all legal and safety requirements.

Signature

Clear

Date