Private-Hire/Taxicab Licensing Application

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Full name *

Address *

Telephone Number(s) *

Drivers License Number *

Name of Licensed Operator you intend to work for: *

Do you have any pre-existing medical conditions? If yes, please specify.

Have you ever been convicted/arrested/charged for a criminal offence? If yes, please specify.

Which license are you applying for? *

Private-Hire (Chauffeur, Limosuine)

Taxicab Operator

Please read the following declaration carefully, DO NOT submit this form if any part of the following declaration is not true. By submitting this application form I confirm the information I have supplied above and in any attachments or additional documents supplied in support of this application, is true to the best of my knowledge and belief. I understand I may be prosecuted if I make a false statement, or omit any relevant information in the completion of this application. I am the person named above and I have either completed the application myself or have satisfied myself the information submitted on my behalf is accurate. *

Ticking this box indicates you have read and understood the above declaration.

Required

Signature & Date *

Submit

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