Car lease scheme - WAKEFIELD WEST PRIMARY CARE TRUST by keara


									               Car Lease Scheme Policy
                 Information Booklet

Version:                1.0

Committee Approved by: Joint Consultative Committee

Date Approved:          5 October 2007

Author:                 Mark White/Leigh Hancock

Responsible Directorate: Corporate Services

Date issued:            October 2008

Review date:            October 2009
                                Version Control Sheet

Document Title:      Car Lease Scheme Policy Information Booklet

Version:             1.0

The table below logs the history of the steps in development of the document.
See example below

 Version      Date            Author       Status              Comment
 1.0        21.10.08       Mark White               Put into new policy template

Standards for Better Health Map

NHSLA Risk Management Standards Map

Performance Indicators

Section                                                                Page

1            Introduction                                               1

2            Aims and Objectives                                        1

3            Scope of the Policy                                        1

4            Accountability                                             1

5            Equality Impact Assessment                                 1

6            Implementation and Dissemination                           1

7            Monitoring Compliance with and the Effectiveness
             of Procedural Documents                                    1

8            Reference                                                  1

9            Associated Documentation                                   1

10           Features of the Scheme                                     2

11           Notes and Conditions for Employees                         3

12           Questions and Answers                                      9


Appendix 1   Equality Impact Assessment tool                            12

Appendix 2   Application Form/Insurance Declaration/Eligibility Form    17
1   Introduction

    This policy sets out the Lease Car Scheme available to employees of NHS
    Wakefield District.

2   Aims and Objectives

    This policy aims to explain the features of the lease car scheme available
    to all staff if they are regularly required to drive as part of their post.

3   Scope of the Policy

    This policy applies to all staff.

4   Accountability

    The Director of Corporate Services is responsible for this policy.

    The Workforce Service Group is responsible for monitoring compliance
    with this policy.

    The Governance Committee is responsible for formal approval of this

5   Equality Impact Assessment

    Wakefield District Primary Care Trust aims to design and implement
    services, policies and measures that meet the diverse needs of our
    service users, population and workforce, ensuring that none are placed at
    a disadvantage over others.

    The PCT uses a single equality impact assessment for all of its policies
    and procedures. The Equality Impact Assessment for this policy is
    included at Appendix 1.

6   Implementation and Dissemination

    This policy will, following ratification by the Governance Committee, be
    disseminated to staff via the PCT‟s intranet.

7   Monitoring Compliance with and the Effectiveness of Procedural


8   Reference


9   Associated Documentation


10     Features of the Scheme

       The lease car scheme has been revised to take account of those
       employees whose business mileage has fallen below 3,000 miles a year
       but, due to the nature of their work they otherwise meet the regular user
       criteria as defined in the General Whitley Council Handbook. In addition,
       the cost to the PCT of providing a lease car under this Scheme must be
       assessed as being financially viable. Regular Car User status is defined

10.1   Travel an average of at least 1,250 miles per year AND necessarily use
       their car on three days per week OR spend an average of at least 50% of
       their time on such travel, including the duties performed during their visits.


10.2   Travel an average of at least 1,000 miles per year and spend an average
       of four days per week on such travel, including the duties performed
       during such visits.

       Contract hire agreements have been negotiated with leasing companies.
       Under the terms of the scheme, the PCT will pay the hire charge and
       insurance premiums. The participating employees will made a fixed
       contribution towards these costs by monthly salary deductions.

       The main features of the scheme are:

10.3   Participating employees will be provided with a new vehicle every three
       years (provided that the scheme remains in operation).

10.4   Maintenance and repair charges (excluding accident repair) are included
       in the hire costs as are road tax and „get you home‟ AA or similar

10.5   The employee makes a payment to the PCT for private use of the car
       including insurance and VAT on the total charge. The employee
       contribution will be made by deduction from their salary.

10.6   The employee is entitled to be reimbursed for business fuel costs. The
       formula used to calculate reimbursement is available on request.

10.7   Employees will have a wide choice of vehicles. All models are available
       from the manufacturers including Ford, Vauxhall, Rover, Nissan, Peugeot,
       Citroen, Volvo, Renault, VW and Fiat.

10.8   The PCT‟s base cars are as follows:

        Vauxhall Omega 2.0 CDX
              o Chief Executive and Directors

        Vauxhall Vectra 1.61 Club 5 Door
              o Senior Managers
              o G Grade and above
              o Common Grading 6 and 7
                 o Agenda for Change Band 7 and above

         Ford Focus 1.6 LX 5 Door Hatch
                o For all other staff

10.9    The employee is free to choose any vehicle depending on their individual
        needs or preferences, but the employee must bear the total additional cost
        of any car which is more expensive than the base car. The car must be
        capable of fulfilling the responsibilities of the post. Vehicles with a „soft
        top‟, if any damage to the roof occurred, private or business, the excess
        will be passed on to the employee.

10.10   At the end of the three-year agreement the employee may purchase their

10.11   Each application for participation in the scheme will be subject to financial
        viability assessment. Financial viability must be demonstrated before any
        application can be processed.

10.12   The employee should be aware of his/her tax liability (see Paragraph 10 of
        the Notes and Conditions for Employees).

10.13   To give employees a further insight into the scheme, this brochure
        includes details of the scheme‟s operation set out in question and answer

10.14   Vehicles can be modified and converted i.e. steering aids, hand controls,
        pedal and seat extensions, and left foot accelerators on request.

11      Notes and Conditions for Employees

        Wakefield District Primary Care Trust has agreed a car scheme, which
        enables employees meeting the necessary criteria to be allocated a Lease
        Car. Any employee allocated a car would be entitled to private use of it
        and would be charged at specified rates. The PCT retains the right to
        refuse any application received.

11.1    Maintenance and Repairs

        The scheme allows for full maintenance which includes the cost of all
        servicing in accordance with the manufacturer‟s schedule, repairs,
        replacement of tyres, batteries, exhaust, etc. Employees will be expected
        to make adequate arrangements for their own transport when the vehicle
        is having its routine service. The PCT is under no obligation to provide
        replacement vehicles following theft/accidents and during length

        Servicing and repairs will be carried out at named service agents
        convenient to employees that have been specifically approved by the

        The cost of repairs and replacements due to deliberate abuse or wilful
        neglect is not included in the contract hire agreement. Any such costs that
        are agreed by the contractor and the scheme controller as appropriate
        may be required to be reimbursed by the employee. Where servicing is not
        carried out at the manufacturer-specified intervals resulting in nullification
        of the warranty, the cost of any unmet warranty claims becomes the
        responsibility of the employee.

        AA Relay and Home Start (or equivalent) services are included within the
        scheme at no additional cost to the employee, and should be used in
        preference to dealer towing in the car – dealer towing may be re-charged.

11.2    Employee’s Responsibilities

11.2.1 Contract hire vehicles are supplied by the contractor on the assumption
       that the cars will be kept in a good and clean condition and to the same
       standard as if the employees owned the cars. It is in the interests of all
       parties that the cars have a high value when returned at the end of the
       contract. If the vehicles are returned with dints and scratches other than
       fair wear and tear an invoice will be issued.

11.2.2 The employee has a specific responsibility for the following:

         Keeping the car in a clean condition, at the employee‟s cost.

         At regular intervals checking the oil, water, battery, brakes and any
          other fluid levels, tyre pressure and condition of tyres and “topping-up”
          as necessary.

         To report to the Fleet Manager in advance should the employee foresee
          that the actual mileage is likely to be more/less than estimated. There
          will be no refunds at the end of a contract.

         Ensuring the anti-freeze level in the cooling system is checked and
          maintained at the level recommended by the manufacturer.

         Reporting defects promptly to the nominated garage or as otherwise
          instructed by the contractor or the Fleet Manager.

         Ensuring that the nominated garage carries out servicing and
          maintenance at the intervals recommended by the contractor.

         Obtaining approval for repairs above the cost specified by the
          contractor and ensuring that invoices are submitted if required as
          instructed by the contractor.

         Ensuring that road fund licences are received from Human Resources
          and displayed by the due date.

         Ensuring the security of the vehicle at all times. Conforming to all
          instructions and recommendations in the manufacturer‟s handbook and
          all other instructions and advice given by the contractor or the PCT.

11.2.3 The employee should bear in mind that he/she will be personally
       responsible for the car‟s roadworthiness as if he/she were the owner of the
       vehicle. Employees should not service, repair or adjust the vehicle
       themselves (other than as mentioned before) and, in particular, must not
        interfere with the odometer (the instrument which records the mileage of
        the vehicle).

11.2.4 The employee is under a duty to report all damage or defects promptly to
       the Fleet manager. Where an employee has damaged the vehicle due to
       the failure to maintain or due to neglect of maintenance or non-reporting of
       defects, then he/she is liable to pay for the resulting repairs.

11.3    Use of Car

11.3.1 The car can be used for normal domestic and pleasure purposes and
       business use by the employee and one other named driver. Use by other
       named drivers may be arranged by agreement with the Fleet Manager.

11.3.2 An employee may take the contract hire car abroad provided that
       permission is obtained from the Leasing Company (4 weeks before

11.3.3 Smokefree Policy – Lease Cars

        You will be probably aware by now that the NHS is going „Smoke Free‟
        from the 1st January 2007. This means that staff are expected not to
        smoke when on duty – whether they are at their place of work, or travelling
        between sites.

        Please be aware that the Trust‟s policy is that lease car holders must
        refrain from smoking, in their lease car when on duty.


        Staff are expected not to smoke when on duty – whether they are at their
        place of work, or travelling between sites. Please be aware that lease car
        drivers must refrain from smoking, in their lease car.

        More information regarding the Smokefree Policy can be found on the
        Internet at the following address.

11.4    Terms of Hire

11.4.1 The allocation of a vehicle will commit the employee to a three-year

11.4.2 Whilst participating in the scheme, employees will be expected to have
       their cars at their disposal, whenever required, for official business.

11.4.3 The PCT reserves the right to offer a second-hand car if another employee
       has released it prior to the termination of use. In such cases, the period of
       use will be the unexpired portion of the lease period, and the contribution
       will be based on the charge when the car was first supplied.

11.4.4 Employees will be required to sign a document agreeing to abide by the
       terms of hire subsequent to collection of the vehicle.

11.5    Costs Borne by the Employee

11.5.1 Once a car has been supplied, the gross lump sum contribution, if
       applicable, based on annual mileage, will be fixed for the period of the
       lease with the exception of:

         Changes in VAT, insurance, road fund tax and other legislative

         Variations in mileage.

11.5.2 Changes in the contribution payable due to the above factors will be
       revised as and when the additional costs are incurred.

11.5.3 Private mileage will be reviewed annually and adjustments will be made in
       the following year where the actual private mileage has exceeded the
       estimate. If, for any reason, private mileage is not reviewed annually; then
       at the end of the lease the private mileage will be calculated and any
       excess over the original quoted figure will be recharged to the driver plus
       VAT. There will be no refunds for over estimated schedules.

11.5.4 Employees will pay for all petrol, oil and other fluids, but will be reimbursed
       for official mileage at the rate calculated in paragraph 6 below.

11.5.5 Fixed penalty fines will always be the responsibility of the employee. Any
       fines passed to the contractor by the police/local authorities, in accordance
       with current legislation, will be passed on to the employee for immediate

11.5.6 Should any modification be required to the vehicle due to statute, the cost
       will be met by the PCT.

11.5.7 The employee will be expected to meet all costs over and above the lease
       cost of the appropriate base vehicle.

11.5.8 Towing by the vehicle is permitted subject to the instructions in the Driver‟s
       Handbook, but the cost of the necessary towing equipment and electrical
       modifications will require to be borne by the employee.

11.6    Cost of Petrol for Business Mileage

        The employee will be reimbursed official mileage petrol costs as
        determined by the Director of Finance.

11.7    Early Termination of Hire

11.7.1 The employee‟s right to a car within the scheme will be terminated:

         on the employee‟s death;

         on the termination of his/her employment by the PCT;

         on the employee‟s retirement or voluntary termination of employment
          within the PCT.
11.7.2 The employee‟s right to a car within the scheme may be terminated by the
       PCT at its discretion in the following circumstances – each case being
       considered on its merits:

         by the breach of any of the conditions of the scheme;

         in the event of the prolonged absence of the employee from normal

         when the employee‟s contributions cannot be recovered from his/her

         when, in exceptional circumstances, an employee applies to terminate
          his/her participation in the scheme;

         any other very exceptional circumstances not provided for in above.

11.7.3 When an employee‟s participation or right to participate in the scheme is
       terminated, the employee may have the option of buying the vehicle at
       current value, including settlement of any contractor penalties for early
       termination, or concluding a new lease contract with the contractor for the
       remainder of the hire period subject to the consent of the leasing
       company. Deductions from salary will continue until the contract with the
       leasing company is formally terminated.

11.7.4 Upon the termination of the employee‟s participation, or right to participate
       in the scheme, the employee must return the car as directed and shall pay
       any outstanding contribution for private use which will be calculated up to
       the date of termination. If the vehicle cannot be reallocated to another
       employee and subsequently has to be returned to the leasing contractor,
       the employee will meet any termination costs incurred in full.

11.7.5 In the event of the employee‟s death in service or on early termination of
       the employee‟s employment contract on the grounds of ill health, there
       shall be no financial penalty to the employee or his/her estate on account
       of the early termination of the contract for private use of the lease car.

11.7.6 In the event that the employee is absent from work for an extended period
       on maternity leave, sick leave or on approved training, an employee who
       has contracted for private use of a lease car may choose to continue the
       private use at the contracted charge or to return the vehicle to the PCT. In
       the case of approved training there shall be no financial penalty to the
       employee on account of early termination of the contract.

11.8    Normal Termination of Hire

        At the end of the lease agreement the following procedure will apply:

11.8.1 The car will be appraised for condition in the presence of the employee
       who may be required to reimburse to the PCT the cost of any repairs that
       are agreed by the contractor and the Fleet Manager as needed to bring
       the car into good condition, taking fair wear and tear into account. In the

        event of any dispute, independent assessors may be consulted on costs
        and repairs involved and the assessor‟s decision will be final.

11.8.2 The employee shall permit representatives of the PCT or the contractor to
       inspect the state and condition of the car at any reasonable time.

11.8.3 The car is available for sale to the employee at the end of the lease period
       based on a valuation agreed with the contractor.

11.8.4 At the end of the contract period, if the employee does not purchase the
       vehicle and if another vehicle is being contracted, the leasing company will
       exchange the previous vehicle for the new contract vehicle. The employee
       will enter into a new agreement with the PCT in respect of the new
       contract vehicle.

11.9    Insurance

11.9.1 The vehicle is covered by comprehensive insurance whilst it is being used
       for private and business purposes.

11.9.2 The employee is responsible for providing adequate insurance cover
       for any personal property fitted to or left within the vehicle.

11.9.3 It should be noted that an employee could lose no claim discount benefits
       when arranging insurance cover for their own car after terminating an
       agreement with the PCT. Most insurance companies will request a letter
       from the PCT confirming that the individual has had no accidents whilst
       under NHS insurance (lease or private) and will automatically continue no
       claims bonus accordingly. Employees should be aware, however, that not
       all insurance companies will accept this, and may reduce no claims
       discount accordingly.

11.9.4 The driving of any vehicles by an employee other than the vehicle
       provided by the PCT is not included within the insurance policy.

11.9.5 The current insurance policy normally carries an excess which is
       payable by the employee in the event of a claim being met by the
       insurance company. A higher excess will apply if the driver is under
       25 years or has less than 1 year’s driving experience.

11.10   Income Tax

        The employee is liable for the payment of income tax on the lease car,
        although this will normally be automatically reflected in an employee‟s tax

        For individuals paid in excess of £8,500 per annum, the provision by the
        employer of a car, which can be used for both business and private
        mileage, is assessed as a benefit in kind.

        With effect from April 2002, new tax regulations will be associated to the
        CO2 emissions a car emits. Please find attached the scale charge

12      Questions and Answers

12.1    If I apply for a car, will I automatically be given one?

        Not necessarily. There is a preliminary requirement that your application is
        financially viable. Your Budget Manager must approve applications. The
        Director of Finance will authorise applications once financial viability has
        been demonstrated.

12.2    Do I have a choice of vehicle?

        An employee may choose any vehicle, which is available. The PCT,
        however, reserves the right to offer a second hand car if another employee
        has released it prior to the termination of the lease agreement. In such
        circumstances, and subject to the Director of Finance‟s discretion, no new
        cars will be leased until all “returned” cars have been reallocated.

        If a larger or more expensively equipped car is chosen, any additional
        lease cost, over and above the “base vehicle”, must be borne by the

12.3    If I use the vehicle for my own personal use, am I required to
        contribute towards the cost?

        Yes, an employee will be asked to give an estimate of his/her private
        mileage during the year, and a charge based on this estimated mileage
        will be made. The charge will be deducted from salary in monthly
        instalments. The private mileage will be reviewed annually and, where
        necessary adjustment made to the employee‟s monthly contribution.

        If an employee does not continue in the scheme for any reason, any debit
        will be settled by a lump sum payment (see question 5 below).

12.4    As the agreement between PCT and me is for three years, what
        happens if I leave the PCT’s employment before the end of the

        There are a number of options available including:

12.4.1 You may purchase the vehicle at the contractor‟s current valuation as set
       out in the agreement (including any early termination penalty).

12.4.2 The contractor may agree to your new employer (if appropriate) accepting
       responsibility for the complete hire agreement.

12.4.3 The contractor may agree to you undertaking full responsibility for the hire
       arrangements for the remainder of the hire period.

12.4.4 The vehicle may be returned to the PCT upon termination of employment.
       If the vehicle cannot be reallocated then the employee will be liable for a
       financial penalty calculated as follows:

         The financial penalty imposed by the Lease Company in respect of the
          employee‟s vehicle.

         Any excess private mileage over and above the amount contracted for
          by the driver.

        NB: The maximum financial penalty for early termination imposed by the
        lease company is as follows:

         Year 1    :       6 monthly contract payments
         Year 2    :       3 monthly contract payments
         Year 3    :       1 monthly contract payments

12.5    What happens to the vehicle after the lease period has expired?

        If the scheme continues to operate and you continue to fulfil the scheme‟s
        eligibility criteria, you can request to be allocated a new vehicle of your
        choice. You have the option of purchasing the current vehicle at its current
        valuation or returning it.

12.6    What happens if I am on long term sick leave/study leave/maternity/
        paternity leave or am suspended from duty?

        You will be entitled to continue to use the car provided you continue with
        the payments for private use.

12.7    Do I have to pay for servicing and repair, and AA membership?

        No. All costs other than petrol and day to day maintenance (e.g. oil
        additional to that provided at servicing) are included in the charge to the
        employee. An information pack on what to do about servicing, etc, will be
        provided with the car.

12.8    What happens if the vehicle is involved in an accident, stolen or
        breaks down?

        You will be required to fill in an insurance form. As normal, it is expected
        that you will not admit liability for any accident. For breakdowns you will
        ring the appropriate recovery firm and they will advise you of the steps to

12.9    Will I be disciplined if I have an accident?

        Not necessarily. However, staff are expected to take reasonable care at all
        times with the vehicle.

12.10   Can I take the lease vehicle abroad?

        Yes, provided that permission has been obtained from the Leasing

12.11   Will I still be able to claim for business mileage?

        The current mileage allowances and lump sum payments payable under
        the General Whitley Council‟s Conditions of Service are not applicable to
        the scheme as the mileage rates incorporate such factors as road fund
        licence, depreciation, etc. A new mileage allowance would be used, based
        on the cost of petrol consumed whilst on official business. A claim form will
        need to be completed and submitted at monthly intervals. This allows us to
        make sure you are on the correct tax code.

12.12   If I am interested, how do I proceed?

        If you consider that you are eligible to participate in the scheme and you
        wish to apply, the first decision you must make concerns the vehicle that
        you require and the people that you wish to use the vehicle. Complete the
        application form (enclosed) and send it to your Budget Holder. This form
        will then be forwarded to the Fleet Manager, Fleet Management,
        Fieldhead, Ouchthorpe Lane, Wakefield. The submission of an application
        is not a commitment to participate in the scheme. On receipt of the form,
        your eligibility will be determined and a quotation will be prepared and
        returned to you.

                                                                        Appendix 1

Equality Impact Assessment

WDPCT has an Equality Impact Assessment Toolkit which should be used, with
the completed proforma enclosed when any procedural document is submitted to
the appropriate committee for consideration and approval.

An initial assessment using the proforma below should be undertaken.

If the initial assessment demonstrates an adverse impact on differing groups, a full
impact assessment must be undertaken using the toolkit.

For further assistance and guidance refer to the Equality Impact Assessment
Toolkit and/or contact the Equality and Diversity Manager.

Proforma for initial assessment/screening of functions, policies, and procedures

Directorate/service              Department                                               Person responsible for the assessment

Corporate Services               Workforce Services                                       Mark White

Name of function/policy/         Date of assessment                                       New policy/function/procedure                   (please tick)
                                                                                          Existing policy/function/procedure         x
Car Lease Scheme                 October 2008

1 Who are the main               List: All Staff
  stakeholders intended to
  benefit from the
  function/policy/ procedure?

2 How will each stake holder     List for each stakeholder: Provide an affordable option for transport for those required to travel as part of their
  benefit? (what are the         post

3 What forces/factors could
  contribute/ detract from the

4 Are there concerns that the   State    Is there any evidence for this?   Score likely risk of
  function/policy/ procedure    yes or                                     impact using
  could have a differential     no                                         grading table (see
  impact on -                                                              pg 14)

Ethnic groups                   No                                         1

Faith group                     No                                         1

Disability                      No                                         1

a) physical (including

                                No                                         1
b) mental

                                No                                         1
c) learning disability

Sexual orientation              No                                         1

Age                         No         1

Gender (including marital   No         1

Socio-economic group         No        1
e.g. homeless

Human Rights                No         1

                                        Risk Assessment Grading Tool

                                                GRADING TABLE
            Risk Assessment                  Circle consequence,                 SCORE
                                          likelihood and total score
                                                 e.g. 2 x 3 = 6                   1
                                                 LIKELIHOOD/PROBABILITY OF REPEAT
               INCIDENT                   None/      Possible    Likely   Highly      Certain
            CONSEQUENCES                 Remote        20%       60%    Likely 90%
                                                     chance     chance    Chance

                                            1            2            3           4               5
        1         Insignificant             1            2            3           4               5
        2         Minor                     2            4            6           8               10
        3         Significant               3            6            9           12              15
        4         Serious                   4            8           12           16              20
        5         Catastrophic              5            10          15           20              25

Green           (score 5 or less)          Low risk           Low priority      Prioritise for action
Amber           (score 6 to 15)            Medium risk        Medium priority            medium priority
                                                                                Prioritise for action
Red       (score 16 to 25)                 High risk          High priority            high priority
                                                                                Reported through the risk
Or any incident recorded as                                                     register. 16+ score senior
Catastrophic regardless of the                                                  management consider
likelihood/probability of repeat                                                informing the board

Classifications of Impact
            Measures of impact

     Level                Descriptor       Example detail description

            1           Insignificant      No perceived impact
                                           May have a minor impact on a few or all people from this
            2               Minor
                                           diverse group
                                           Will have a significant impact on a few or all people from
            3             Significant
                                           this diverse group
                                           Will have serious consequences on a few or all people from
            4              Serious
                                           this diverse group
                                           Could cause death and/or result in major litigation and/or
            5          Catastrophic
                                           create significant press interest

            Measures of likelihood

     Level                Descriptor       Example detail description

            1          None/Remote         The impact may only happen in exceptional circumstances
                       Possible 20%
            2                              The impact could occur at some time
                        Likely 60%
            3                              The impact may well occur at some time
                     Highly Likely 90%
            4                              The impact will occur in most circumstances
            5         Almost Certain       The impact is expected to occur in most circumstances

                                                                                           Appendix 2

Application for a Lease Car
Please note, your application will only be approved if there is budgetary authorisation from the
Finance Department. The Trust has the right to decline any applications, or offer a suitable
alternative vehicle to those chosen. Please attach a copy of your driving licence and of any named
drivers. This form cannot be processed unless all relevant sections have been completed.
Section 1


Grade:                                     National Insurance No:

Home Address: __________________________ Base Address: __________________________
                __________________________                             __________________________
                __________________________                             __________________________
                __________________________                             __________________________
Home Tel:      __________________________                  Work Tel:   __________________________

What is your current user type (please tick as appropriate): Lease       Standard      Regular    None
Vehicle Choice
If you have a preference, then please list these in section 2. If you have no particular make and
model in mind then please list your requirements in section 3. A quote will be sent to you with a
selection of the cheapest vehicles that match your specification.
Section 2                            Please state Make & Model, Engine Size, Fuel, Body Style, etc
                                     (i.e. Vauxhall Astra 1.8L Turbo Diesel 5dr Estate)
Choice of Car:                       1
(in preference order)
Please go to Section 4

Section 3
Body Style:
(ie Hatch, Saloon, Estate, etc)

Engine Size:                Minimum                              Maximum
Number of Doors:            2        3     4     5         6    7      No Preference       (please tick)
Drive:                      Automatic             Manual               No Preference
Fuel:                       Petrol                Diesel               No Preference       (please tick)

Section 3 continued…

Finally, please state your price range in terms of monthly cost (excluding tax liability).
(i.e. If you are prepared to spend between £100 and £130 per month on a vehicle, for example)

Price Range:                           Monthly Minimum Cost                     £                 Maximum Cost                £

Section 4

Estimated Annual Mileage:                        Year 1                       Year 2                        Year 3
Business Mileage:
Private Mileage:
Total Mileage:

Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . .

Insurance Declaration

Date of Birth:                                             Occupation:

Date Passed Test:

Other Drivers of Car:

Name of Diver:                                                                Name of Driver:

Occupation:                                                                   Occupation:

Date of Birth:                                                                Date of Birth:

Date Passed Test:                                                             Date Passed Test:

Do any of the above suffer from any disability (mental or physical) which is likely, or may become
likely, to affect fitness as a driver?          Please tick: Yes             No

If yes, please give details …………………………………………………………………………………


Have any of the above been convicted of any driving offence? Please tick: Yes                                                     No

If yes, please give details ………………………………………………………………………………….


I verify that the information given is accurate and I will inform Human Resources of any future
changes to the above declaration. Please attach a copy of your driving licence and of any
named drivers.

Signature: …………………………………………………………………. Date: ……………………….
                                                    Application for a Lease Car

                                     For Completion by Authorised Budget Holder

Have you checked with Finance that there is a budget available for the proposed application? Yes No

Have you checked that the individual meets the business mileage criteria, by assessing the last two
years mileage claims?                                                                        Yes No

Base vehicle for employee:

I can confirm that there is a budget for the proposed application and I have made the employee aware
that the application may be withdrawn if the vehicle chosen is non-viable.

Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Designation: . . . . . . . . . . . . . . . . . . . . . . . . . .



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