Motoring Questionnaire

Please provide the following information in full:

Full name, including title (required)

Date of birth

National Insurance Number

Full address

Email address (required)

Telephone number(s)

Marital status

Number of dependents, including their age(s)

Are you employed?
If yes, please complete the following questions. *
If no, please explain how you are supported financially

Name of employer *

Job title *

Your court date

Magistrates Court
(e.g. Milton Keynes, Bedford, Luton etc)

When were you charged/when did you receive your court summons?

Alleged offence

Date of alleged offence

Circumstances of alleged offence

Details of your driver’s licence
(e.g. Provisional, Full UK etc)

How many points are already on your driver’s licence?

Vehicle registration

Vehicle make and model

Were you interviewed by the police? If so, where (e.g. Milton Keynes police station; roadside etc)

If interviewed, please summarise what you said

Please give details of any previous convictions/cautions etc

Why do you accept responsibility for this offence?

What effect would it have on your life if you were disqualified from driving?

* Please enter the Verification code you see above:

Please forward your cheque*** in the sum of £250 (monies on account) payable to Bastian Lloyd Morris Solicitor Advocates to the following address:

Ms Silpa Mistry
BLM Solicitor Advocates
Sovereign Court
Witan Gate East
Central Milton Keynes
MK9 2HP

***Alternatively, you may pay over the phone by debit or credit card by calling our Accounts Manager on:
01908 546580