Mileage Declaration Form

Please complete and sign this declaration and return to Brentacre Insurance within 7 days.

Your Details

Policy Holder Name *

Email Address *

Vehicle Details

I hereby declare that my vehicle:

Make/Model *

Registration Number *

Has a current mileage reading of:

Mileage *

Declaration

I can confirm that the mileage covered will not exceed the limitations as set out during inception in the forthcoming 12 months. I understand that I will need to contact Brentacre if I need more mileage and should I exceed my allocation and not advise Brentacre, this could have negative implications with how any claim is dealt with. If I sell my vehicle, I understand that I will need to declare the odometer reading at the time and date of sale.

By ticking this box, you confirm that you understand the limitations of your policy and that all information provided is factual

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