{"content":[{"text":"WHERE DID YOU HEAR ABOUT US? ________________________________________","bbox":{"left":0.121008,"top":0.149972,"width":0.756289,"height":0.01535800000000001}},{"text":"ADDITIONAL DRIVER INFORMATION, IF APPLICABLE:","bbox":{"left":0.121008,"top":0.192446,"width":0.434335,"height":0.01535800000000001}},{"text":"FIRST NAME ________________________________________________________","bbox":{"left":0.121008,"top":0.218387,"width":0.754606,"height":0.01535800000000001}},{"text":"SURNAME _________________________________________________________","bbox":{"left":0.121008,"top":0.244328,"width":0.750129,"height":0.015357999999999983}},{"text":"MOBILE NUMBER _____________________________________________________","bbox":{"left":0.121008,"top":0.270292,"width":0.757873,"height":0.015357999999999983}},{"text":"EMAIL ____________________________________________________________","bbox":{"left":0.121008,"top":0.296233,"width":0.7551549999999999,"height":0.015357999999999983}},{"text":"ADDRESS__________________________________________________________","bbox":{"left":0.121008,"top":0.322173,"width":0.753801,"height":0.015357999999999983}},{"text":"_________________________________________ POST CODE ______________","bbox":{"left":0.121008,"top":0.348114,"width":0.751903,"height":0.015357999999999983}},{"text":"DATE OF BIRTH _______________________ AGE __________________________.","bbox":{"left":0.121008,"top":0.37409,"width":0.7558279999999999,"height":0.015357999999999983}},{"text":"NATIONALITY ______________________________________________________","bbox":{"left":0.121008,"top":0.400031,"width":0.753693,"height":0.015357999999999983}},{"text":"DRIVING LICENCE NO_________________________________________________","bbox":{"left":0.121008,"top":0.425972,"width":0.7530190000000001,"height":0.015357999999999983}},{"text":"TYPE OF LICENCE ______________________ YEARS HELD ____________________","bbox":{"left":0.121008,"top":0.451913,"width":0.7514989999999999,"height":0.015357999999999983}},{"text":"NO. PENALTY POINTS____________________","bbox":{"left":0.121008,"top":0.477877,"width":0.410609,"height":0.015357999999999983}},{"text":"NATIONAL INSURANCE NUMBER __________________________________________","bbox":{"left":0.121008,"top":0.503818,"width":0.758707,"height":0.015357999999999983}},{"text":"Have you had any accidents or \n convictions within the last 5 years? \n Please provide details. \n Have you been refused motor insurance?","bbox":{"left":0.130685,"top":0.530329,"width":0.363795,"height":0.061561999999999895}},{"text":"Do you have any disabilities, mentally or \n physically? Do you suffer from diabetes, \n heart conditions or fits? Please provide \n details.","bbox":{"left":0.130685,"top":0.607604,"width":0.354533,"height":0.061253}},{"text":"PLEASE EMAIL COPIES OF DRIVING LICENCES AND 2 RECENT UTILITY BILLS, DATED WITHIN \n 90 DAYS OF YOUR HIRE, PER DRIVER, SHOWING MATCHING HOME ADDRESSES.","bbox":{"left":0.121008,"top":0.695154,"width":0.745178,"height":0.03189199999999992}},{"text":"I CONFIRM I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS PRIOR TO MAKING \n A BOOKING WITH COAST2COAST CAMPERS LTD.","bbox":{"left":0.121008,"top":0.737629,"width":0.754752,"height":0.031891}},{"text":"SIGNATURE Driver 1 ____________________________ DATE __________________","bbox":{"left":0.121008,"top":0.796375,"width":0.7559879999999999,"height":0.015357999999999983}},{"text":"SIGNATURE Driver 2 ___________________________ DATE __________________","bbox":{"left":0.121008,"top":0.822316,"width":0.753908,"height":0.015357999999999983}},{"text":"OFFICE NOTES:","bbox":{"left":0.121008,"top":0.878219,"width":0.12413999999999997,"height":0.015357999999999983}}],"images_bbox":[{"left":0.520413,"top":0.042046,"width":0.358787,"height":0.08141}],"images_bbox_not_text_overlap":[{"left":0.520413,"top":0.042046,"width":0.358787,"height":0.08141}]}