Duty of care

Employees Own Car Use Form Example

 Employees Use Of Own Car Form – Occasional Use

Name………………………………………………

My current driving licence is valid and the number is  ………………………………………….

Anticipated round trip mileage…………

Company agreed maximum is 100 miles – above this figure use alternative – public transport, hire car or another company vehicle.

Make of own car…………………………………..

Model…………………………………………………….

The company does not allow the employees use of their own cars as follows:

Sports cars, 4×4’s, vans. 

Number of doors……………………………………

Petrol / Diesel / Hybrid / Biofuel/ Electric

Reg No…………………………………………………….

Age of car……………..years

The company only allows the use of employees cars which are less than 5 years old.

Does the car have a current MOT if applicable YES / NO

The company only allows the use of employees cars which have a valid MOT if applicable.

Is the car’s service record up to date?   YES / NO

The company only allows the use of employees cars which are serviced according to the manufacturer’s recommendations

Does the car have up to date comprehensive insurance for business use and covering the conditions to which the car will be put to use?  YES / NO

The company only allows the use of employees’ cars with up to date comprehensive insurance for business use.

Signed……………………………………………………………..  Date………………………………………..