• Completed by

  • Date completed

  • Learner Name

  • Date of Birth

  • Retailer

  • Date of last contact (training, review, observation)

  • Reason for withdrwal

  • Full details of reason for withdrawal

  • Details of support given to learner

  • Is there a vacancy at the dealership

  • Details of what has been done to retain the learner

  • Is the learner seeking a placement at another dealership

  • Assessor/Reviewer signature

  • Manager signature

  • Details why there is no Manager signature

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