Wheels 2 Work e-Motorbike Application

Your Personal Details

Name

First

Last

Your Date of Birth

Your Contact Details

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email

Confirm Email

example@example.com

Phone Number

Application to Tees Valley Wheels 2 Work

How would a motorbike help you? Please let us know the reason why you are applying to the Tees Valley Wheels 2 Work Scheme

I am applying for a motorbike because...

I qualify for the scheme because I am

in Employment or have a job offer
in Higher Education
in Training

The name of my Employer is

The name of the organisation employing you.

The name of my Higher Education institution is

The name of my Training Provider is

Driving Licence Information

What type of Driving Licence do you hold?

Full Car Licence
Full Motorcycle Licence
Provisional Driving Licence

Compulsory Basic Training (CBT)

Compulsory basic training (CBT) is a course you usually have to take before you ride a moped or motorcycle on the road.

The training makes sure you can ride safely on your own while you practise for your full moped or motorcycle test.

CBT is not a test that you pass or fail.

Find out more at www.gov.uk/motorcycle-cbt

Do you already hold a Compulsory Basic Training Certificate (CBT)?

Yes
No

Upload your CBT

Click or drag a file to this area to upload.

Do you undertake to go on a CBT course?

Yes
No

Booking a CBT course

There is a one off fee for going on a CBT course which can vary depending on the day and time of the course. You can find courses close to you using gov.uk/find-motorcycle-training

Please note: if you do not agree to undertake a CBT course, then we will not be able to offer you a motorcycle.

Verification of Your Licence Details

In order to process your application we will need to confirm your drivers licence. You can either do this by uploading a copy, taking a photograph or by providing us with a code generated by the .gov website: https://www.gov.uk/view-driving-licence

Would you like to

Upload a copy of your Driving Licence
Provide us with a Verification Code from www.gov.uk/view-driving-licence

Upload your Driving Licence Here

Click or drag files to this area to upload. You can upload up to 2 files.

You can use this service to create a licence ‘check code’ to share your driving record with us, generate a code from www.gov.uk/view-driving-licence by clicking here.

Enter the Licence 'Check Code' provided by .gov.uk

Enter the last 8 digits of your drivers licence

Insurance Questions

These questions are required by our insurer

Do you have somewhere secure that you can store the motorbike when not in use?

Yes
No

Have you been involved in a motor accident or made a claim against a motor insurer at any time in the last 3 years?

Yes
No

Please provide details of your accident or claim below

Have you been convicted of any motoring offences in the past 5 years or do you have any prosecutions pending?

Yes
No

Please provide details of any motoring offences and/or pending prosecutions

Have you been disqualified from driving during the past 11 years?

Yes
No

Please provide details of your disqualification

Have you ever been convicted of a criminal offence?

Yes
No

Please provide any details of any convictions

Have you ever suffered from any physical or mental infirmity that would affect your ability to drive and/or be reportable to the DVLA?

Yes
No

Please provide any details of any physical or mental infirmity

Have you ever been refused motor insurance or quoted an increased premium or had special terms imposed?

Yes
No

Please provide details of any refusals, increased premiums or special terms

Have you been a resident in the United Kingdom for LESS than 3 years?

Yes
No

Please provide details of your residency

Terms and Conditions

I agree to {terms & conditions!}.

Where did you hear about the scheme?