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