APPLICATION FOR A PRIVATE HIRE/HACKNEY CARRIAGE OR JOINT DRIVER’S LICENCE

Which Licence are you applying for*
(Please select one)
- Hackney Carriage Driver
- Private Hire Driver
- Joint Driver
Type of Licence*
- Grant [New]
- Renewal
Renewal details
Licence Number*
Please enter your licence number here
Licence expiry date*
Please type or select expiry date here
DD slash MM slash YYYY

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APPICANTS DETAILS CONTINUED
Have you ever been refused a licence to drive a Hackney Carriage or Private Hire Vehicle with this or any other Authority?*
- Yes
- No
Have you ever held such a licence but had it suspended or revoked?*
- Yes
- No
Name and Address of Taxi Operator/Company for whom you will be working for (If applicable)

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CONVICTIONS OR CAUTIONS
Signature*
If you agree to the above statement then please sign in the box below
Date*
DD slash MM slash YYYY
CRIMINAL CONVICTIONS OR CAUTIONS
Have you any ?*
- Criminal convictions/cautions
- No criminal convictions/cautions
Details of criminal convictions/cautions*
Please click on the plus (+) sign to add more entries
DATE *CRIMINAL CONVICTIONS/CAUTIONS COURT SENTENCE
MOTORING CONVICTIONS/CAUTIONS/FPNs
Have you any ?*
- Motoring convictions/cautions/FPNs
- No Motoring convictions/cautions/FPNs
Details of Motoring convictions/cautions/FPNs
Please click on the plus (+) sign to add more entries
DATE *MOTORING CONVICTIONS/CAUTIONS/FPNs COURT SENTENCE

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DECLARATION
Signature*
If you agree to the above statement then please sign in the box below
Full Name*
Date*
DD slash MM slash YYYY

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National Register of Taxi Licence Refusals and Revocations (NR3)
Training Course Declaration
I understand I must complete all training courses required by the current Hackney Carriage and Private Hire Licensing Policy before my licence will be granted.*
Please sign in the box below
Date*
DD slash MM slash YYYY

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Renewal details

DATE	*CRIMINAL CONVICTIONS/CAUTIONS	COURT	SENTENCE

DATE	*MOTORING CONVICTIONS/CAUTIONS/FPNs	COURT	SENTENCE