Fillable HACKNEY CARRIAGE AND PRIVATE HIRE VEHICLE ACCIDENT REPORT (Newcastle-Under-Lyme Borough Council)

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HACKNEY CARRIAGE AND PRIVATE HIRE VEHICLE ACCIDENT REPORT (Newcastle-Under-Lyme Borough Council)

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HACKNEY CARRIAGE AND
PRIVATE HIRE VEHICLE
ACCIDENT REPORT FORM
Notification of the accident should be given in writing to Licensing Services within 72 hours.
All parts of this form must be completed for your application to be processed.
Driver details
Badge number
Driver’s name
Address
Post code
Telephone
number
E-mail address
Vehicle details
Vehicle plate
number
Vehicle
registration
Private Hire licence Hackney Carriage licence
Name of the driver at the time of the accident Badge number at the time of the accident
Vehicle make
Vehicle model
Vehicle colour
Page 1 of 3
Accident details
Date of accident
Place of the
Accident
Time of accident
(24 hour clock)
Description of
the accident
Was accident reported to the Police?
Were any passengers injured?
Have you returned the taxi licence plate? Yes No
If you checked “No” please state why
Vehicle damage
Indicate clearly on the diagram, the position and type of damage caused as a result of this
accident. Type S for scratch, D for dent and M for missing parts.
Page 2 of 3
Additional notes
Declaration
I confirm that all the details provided are correct and that i will notify the council when any repairs
to the vehicle have been carried out. I confirm that the vehicle will not be used for hire or reward or
public hire until the repairs have been inspected by the council’s engineer.
Call 01782 620803 to arrange an appointment to have an accident damage inspection.
Signed
Name
Date
Please print and return this form to Licensing Services, Newcastle-under-Lyme Borough Council
Barracks Road, Newcastle-under-Lyme, Staffordshire, ST5 1BL
or e-mail licensing@newcastle-staffs.gov.uk
OFFICE USE ONLY – NOT TO BE COMPLETED BY THE APPLICANT
Date Submitted DD/MM/YYYY
Application reference 0123456
E-mailed form to YES/NO
Depot Garage
Scanned to APP DD/MM/YYYY
Inspection completed DD/MM/YYYY
Plates returned YES/NO
Page 3 of 3
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HACKNEY CARRIAGE AND PRIVATE HIRE VEHICLE ACCIDENT REPORT (Newcastle-Under-Lyme Borough Council)

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Completed 17 December 2020

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