Owner/ Supplier Full Name (required)

Email (required)

Mobile

Owner/ Supplier Driving License

Owner/ Supplier Address

Car Details (Model & Year)

Registration No (if any)

Vin No (if any)

* I agree to sell the vehicle with above details to North Car Removals.

* I declare that I have full title to the vehicle & accessories and there are no monies owing to the third party concerning the vehicle by way of lease, hire, Purchase agreement, bill of sale, personal loan, promissory note, or any other agreement, and the vehicle and accessories are completely unencumbered.

*I declare that there are o fines or infringement notice outstanding in relation to the given vehicle.

*I declare that the vehicle has not been involved in any theft.