NOTIFICATION OF
CHANGE OF NAME/ADDRESS
THIS FORM MUST BE COMPLETED WITHIN
7 DAYS TO COMPLY WITH YOUR LICENSING CONDITIONS
Pl
ease complete section A and C for change of name, and section B and C for change of address.
SECTION A: Driver’s previous name Driver’s current name
SECTION B: Driver’s previous address
Post Code
Driver’s current address
Post Code
SECTION C: Telephone number E-mail
Complete for all the licences you hold. If you do not hold that licence, type “None”.
B
adge number Hackney Carriage
Dual licence
Private Hire
Private Hire operator’s number
Vehicle Plate number Dual Licence
Private Hire/
Hackney Carriage
Receipt number
DECLARATION Name Date
I HAVE FULLY COMPLETED THE FORM AND DECLARE THAT I AM THE PERSON ABOVE
AND THAT THE INFORMATION PROVIDED IS CORRECT.
APPLICANTS ARE ADVISED THAT KNOWINGY MAKING A FALSE STATEMENT IS A
CRIMINAL OFFENCE PUNISABLE BY A FINE ON CONVICTION.
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WHAT TO DO NEXT
1. Contact Customer Services on 01782 717717 to make your payment.
Licence fees can be found here www.newcastle-staffs.gov.uk/all-services/business/licensing/
private-hire-and-hackney-carriage-licence-fees
2. Following successful payment, E-mail this completed form to
licensing@newcastle-staffs.gov.uk with a copy of our payment receipt.
The change of address will only be authorised upon receipt of payment and a
completed application form.
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