Duty of care

Car Order Approval Form

Car Order Approval Form

Part 1 – To Be Completed By Driver

Name Job Title
Car Grade/Level Dept
Mobile Number Cost Centre
NI Number Employee Number

Delivery Address

 
                                          Postcode:

Part 2 – To Be Completed By Driver In Conjunction With Fleet Manager

Details Of New Car
Manufacturer

Model

                                                    Petrol/diesel
Engine Size  
Colour 1st   Choice   2nd   Choice  
Trim 1st   Choice   2nd   Choice  
CO2 Emission   Avg MPG P11D Figure  
 
Accessories Details Cost
1.
2.
3.
4.
5.
Details Of Current Car
Registration Number Today’s Mileage  
Current Mileage Per Annum (Business and Private) New Car’s Estimated Annual Mileage  

I understand the impact of CO2 emission figures on Benefit In Kind Taxation and how the figures are calculated.

Part 3 – Payroll Authorisations – To Be Completed By The Driver

a) Trade Up / Trade Down Approval – I agree I have traded up/down* and authorise the amount of £……………… to be deducted (plus employer’s NI contribution / paid* monthly for the period of the car contract/agreement in my salary (* delete as appropriate)

b) I authorise the company to deduct any remaining charge for the remainder of the car contract/agreement, for the cost of any upgrade from any final salary payments should I leave the company before the rental/payment period is complete.

c) I authorise the company to deduct any fine and administration fees from my monthly salary if I leave any fines unpaid in conjunction with the rules laid out in the company car policy.

Driver’s Name ………………………………….. Driver’s Signature ………………………………….. Date …………..

Please ensure the above information is correct including the driver’s car grade.

Part 4 – Company Authorisation

 

Director’s Signature ………………………………….. Date …………..

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