APPLICATION FOR OR
GRANT RENEWAL
Surname (Mr/Mrs/Miss/Ms)
Forename(s)
Address
Email address
Contact telephone no(s)
PRIVATE AND CONFIDENTIAL
Post code
Plate No.
National Insurance no
Tel: 01753 875664 Email: licensing@slough.gov.uk Web: www.slough.gov.uk
Town and Country of birth
/
Date of birth
/ /
When completing this application please:
• Use BLOCK CAPITAL letters
Provide a response to every question. We will not accept your application if you have not completed every relevant section or if
required documents are missing.
Private hire vehicle licence
Hackney carriage vehicle licence
Driving licence no
Please provide the ‘check code’ for sharing your DVLA drivers licence information
I authorise Slough Borough Council to use the information detailed in this application to obtain the ‘check code’ on my behalf.
DVLA driving licence information
Registration number Vehicle make
Vehicle model Date of registration
Colour Engine CC Fuel type No of passengers
Vehicle details
Insurance company name
Policy/certificate No:
Start Date: Expiry Date:
Insurance
Have you previously held or applied for a hackney carriage or private hire vehicle licence
with SBC or any other licensing authority? Yes No
Have you ever had a hackney carriage or private hire vehicle licence:
(a) Refused Yes No
(b) Suspended Yes No
(c) Revoked Yes No
If yes, please give details including date, authority and reason
If YES, which licensing
authority?
Previous licenses
Do you hold a private hire or hackney carriage vehicle licence with SBC or any other licensing authority? Yes No
If YES, please complete the following details:
Issuing licensing authority Licence No(s)
Additional vehicle licences
Issuing Garage:
Issue Date: Expiry Date:
Mileage: Certificate No.
Certificate of compliance (MOT)
Please ensure the documents listed below are submitted with the application.
DVLA drivers licence
Certificate of Compliance (MOT)
Valid certificate of insurance
Vehicle registration document (V5)
Application check list
This section must be completed for all private hire vehicle applications. Hackney carriage vehicle licence holders only require an
operator signature if they work for one.
All licensed private hire operators you currently work for must complete and sign below:
First operator
Operator Name
Operator licence No
Signature
Please print name
Date
Second operator
Operator Name
Operator licence No
Signature
Please print name
Date
Declaration of Private Hire Operator (to be completed at every application)
click to sign
signature
click to edit
click to sign
signature
click to edit
Designed & Printed by Slough Borough Council TL/3641/02-08-18
Application date Licence expiry date
Receipt number Licence fee
Licence start date
OFFICE USE ONLY
I hereby certify that to the best of my knowledge and belief that the information I have given is correct. I have given it
knowing that I shall be liable to prosecution if I have knowingly or recklessly made a false statement or omitted any material
particular to this application. I accept that Slough Borough Council (SBC) reserves the right to clarify any of my answers or
require further information in accordance with the provisions of the Town Police Clauses Act 1847, the Local Government
Miscellaneous Provisions Act 1976 and any other modification or re-enactment thereof.
I acknowledge that the licence issued to me as detailed above, remains the property of SBC and must be returned to the
council on demand. I understand I must return the licence (including the ID badge) within7 days following the revocation or
suspension of the licence under section 60 of the Local Government (Miscellaneous Provisions) Act 1976.
Applicant Declarations
Officer signature Date
Notes
Policy booklet issued
Signature of applicant Date
click to sign
signature
click to edit
click to sign
signature
click to edit
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