Guildford Borough Council will use your information within the Data Protection Act.
Any disclosures or sharing of information will only take place where required or permitted by law.
Visit www.guildford.gov.uk/taxi for information about licensing
Is your vehicle off the road?
If No, is the vehicle still being driven
for hire and reward?
If yes, will the vehicle be repaired?
If No, will you be replacing the vehicle
on this licence?
Give full address where the vehicle is being kept:
If the vehicle is off the road, and will not be repaired,
you will need to return the internal and rear plates,
and prove that you have removed the livery
(hackney carriages) or return the door signs (private
Warning:
Failing to provide the required information or providing false or incorrect information may result in prosecution.
Declaration:
I (name) _________________________________ am the and declare
that the above information is true. I understand that it is a criminal offence to make a false statement or omit any
material particular from this document.
Signed: _____________________________________ Dated: _____________
When completed, deliver this form to: Guildford Borough Council, Licensing Team, Millmead House,
Millmead, Guildford, GU2 4BB or email a scanned (with signature) version to regulatoryservices@guildford.gov.uk
Describe damage to licensed vehicle: i.e. severe damage, superficial etc
Injuries to self?
(Yes/No)
Other vehicles involved?
(Yes/No)
Injuries to passengers?
(Yes/No)
Name, address and telephone number of passengers (continue on separate sheet if required):
Name & Address
Telephone Number
Name & Address
Telephone Number
Third Party Vehicle
(If more than one vehicle involved please use additional sheets to supply this information for each vehicle)
Describe damage to third party vehicle: i.e. severe damage, superficial etc
Third Party Vehicle Details
Registration Driver
Address of Driver
Telephone Number
Injuries to driver?
(Yes/No)
Injuries to passengers?
(Yes/No)
Name, address and telephone number of passengers (continue on separate sheet if required):
Name & Address
Telephone Number
Name & Address
Telephone Number
Was the accident reported to the Police?
If yes, what is the reference number?
Was the accident reported to your
insurance company?
If yes, when was it reported?
