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
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