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Request to Alter or Replace an Odometer Vehicle Details Year of Manufacture

Make / Model

Registration number

VIN number

Owner name

Telephone

Odometer details Odometer Details Current reading

New reading

Reason for alterations and/or replacement

Your details Your Details Surname

First name

Address

Postcode

Telephone

Fax

Name of person or business undertaking work Telephone

Fax

Declaration I acknowledge that this declaration is true and correct and I make it in the belief that a person making a false declaration is liable to the penalties of perjury.

Signature

Date

Before Me

Date

(Signature of Authorised Witness) Name

Address

Authority

The witness must print their name, address and their authority under section 107A of the Evidence Act 1958 to witness a statutory declaration


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