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