Fillable NOTIFICATION OF CONVICTIONS (Newcastle-Under-Lyme Borough Council)

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NOTIFICATION OF CONVICTIONS (Newcastle-Under-Lyme Borough Council)

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NOTIFICATION OF CONVICTIONS
HACKNEY CARRIAGE AND PRIVATE HIRE
Driver’s name
Driver’s address
Post Code
Telephone number E-mail
Complete for all the licences you hold. If you do not hold that licence, type “None”.
Badge number Dual
Hackney Carriage/Private Hire
Vehicle registration
If the offence happened in a vehicle
Date of the offence
Location of the offence
Details of the offence
Date of conviction
Decision of the Court
Fines, ban incurred, etc.
DVLA check code
www.gov.uk/check-driving-information
DECLARATION Name Date
I HAVE FULLY COMPLETED THE FORM AND DECLARE THAT I AM THE PERSON ABOVE AND THAT
THE INFORMATION PROVIDED IS CORRECT. I UNDERSTAND THAT MAKING A FALSE STATEMENT IS
A CRIMINAL OFFENCE PUNISABLE BY A FINE ON CONVICTION.
FOR OFFICE USE ONLY - NOT TO BE COMPLETED BY THE APPLICANT.
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NOTIFICATION OF CONVICTIONS (Newcastle-Under-Lyme Borough Council)

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Completed 17 December 2020

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