Application for a Hackney Carriage / Private Hire Drivers Licence

Application for a Hackney Carriage / Private Hire Drivers Licence

Town and Police Clauses Act 1847

Local Government (Miscellaneous Provisions) Act 1976
With your application you must provide the documents detailed in the checklist at the end of this form. If these documents are not provided or have expired then your application will be rejected.

Please complete all sections of the application form. Incomplete applications will be rejected and returned by 2nd class post, which will delay the process. If you have any questions relating to the application process or requirements, please contact the Licensing Office 01276 707100 or email licensing@surreyheath.gov.uk

Upon submission of this form you will be redirected to our online payments page where you will be able to make payment for this application. Currently, the cost is £249.00.
Please indicate which type of licence you are applying for:

PERSONAL DETAILS
Name*

First NameLast Name
Have you been known by any other name?*

Date of Birth:*

DayMonthYear
Place of Birth:*
National Insurance Number:*
Nationality:*
Email Address*
example@example.com
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number
Please enter a valid phone number.
Address:*

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Have you lived and worked in the UK since birth, without interruption?
If NO please give details:

DRIVING LICENCE DETAILS
Driving Licence Number:
Is your Driving Licence registered in your current address?
Valid Until:

DayMonthYear
DVLA Access code:
(8 characters upper and lower case and numeric)

Endorsements:

	Offence	Points	Date
Endorsement 1
Endorsement 2
Endorsement 3
Endorsement 4

EMPLOYMENT
Do you currently or have you previously held a Hackney Carriage / Private Hire Driver’s licence with Surrey Heath Borough Council or another local authority, including Transport for London?
Have you ever been refused a Hackney Carriage/Private Hire driver’s licence with another local authority/TFL, or had a licence suspended or revoked?
If YES, please give details:
Current Occupation:
Name of current employer:
Address of current employer:

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Will you be carrying out any other employment while working as a licensed driver?
If YES, please provide details of employment and hours worked:
I understand that should I engage in other employment, I also agree to partake of sufficient rest and refreshment after finishing work before commencing driving for hire.
Names of all Private Hire Operators or Hackney Carriage Proprietor in Surrey Heath you will be driving for:
If you currently do not know whom you will be driving for, you must notify the Council should you start working for an operator or proprietor.
Do you intend to drive a wheelchair accessible vehicle?
Have you completed the DVSA wheelchair assessment?

MEDICAL HISTORY
Have you ever suffered from any physical or mental condition or illness or other disability which could impair your ability to drive?
Have you ever been advised by a doctor that you should not drive?

OFFENCE HISTORY
Please give details of any Convictions, Spent Convictions, Motoring Offences (including endorsements, periods of disqualification and driver awareness courses), Cautions, Discharges, Fixed Penalty Notices, Anti-Social Behaviour Orders, County Court Judgements, Warnings, Reprimands, /Restraining Orders, Criminal Behaviour Order or if you are subject to current enquiries which could lead to any of the above in the box below.

A previous conviction may not prevent you from obtaining a licence. Please refer to the Council’s policy on convictions for further guidance.

If you omit any information your application is likely to be refused and you could be prosecuted.

Offence History

	Detail of conviction, caution, charge or notice	Date of conviction, caution, charge or notice	Issuing Authority (Court / Police)	Sentence
1
2
3
4
5
6

Have you ever been convicted of an offence in another country?
If YES, please give details:
Have you ever been arrested but not charged?
If YES, please give details:

CERTIFICATES
Have you completed the Safeguarding Adults and Child Sexual Exploitation Course?
If YES, what date did you complete the course

DayMonthYear

DECLARATION
I HEREBY make an application to Surrey Heath Borough Council for the grant of a Hackney Carriage / Private Hire Drivers licence subject to the Statutes, Regulations, Policies and Conditions relating to the same for the time being in force.

I declare that I am over the age of 21 and I have held a full DVLA licence (or equivalent) for at least one year, and I have the right to live and work in the United Kingdom.

I declare that I have checked the information on the application and to the best of my knowledge and belief it is correct. I understand that it is an offence for any person to knowingly or recklessly make a false statement or to omit material information which is relevant to this application for which I could be prosecuted and any licence issued suspended or revoked.

I declare that I have supplied all the appropriate supporting documentation listed in the checklist and I am aware that if any of the information supplied on this application should change, I need to inform the Council in writing and pay the fee for amending the licence, if applicable.

I understand that I must undertake to comply with the legislation, byelaws, policy, code of conduct and conditions of licence as they are now, or may hereafter be in force, for regulating Hackney Carriage or Private Hire business and drivers within the said borough. I understand that if my application is refused, or granted and subsequently revoked for any reason; my details will be relayed to the NAFN (https://www.surreyheath.gov.uk/about-council/information-and-data/data-protection/data-matching) to feature on the DFT’s National Register or Refusals and Revocations, this will be held for a period of 11 years. All applicants will have their details checked against the NR3 register and any relevant information taken into account in assessing the application. Where an application is refused, or where a licence is granted but subsequently revoked, this information will be entered into the register. www.nafn.gov.uk
I understand the above declaration and to the best of my knowledge the details of my application are correct

Tick to confirm
Date

DayMonthYear
The Council is the Data Controller of the information you provide and we have a statutory duty to collect and process the information to be compliant with the Local Government (Miscellaneous Provisions) Act 1976 and Town and Police Clauses Act 1847. This is part of our public task obligations as a Local Authority to ensure whether a person is ‘fit and proper’ to hold a Hackney Carriage or Private Hire Driver licence. This also includes processing information on medical checks, DBS check and DVLA checks. We may share your information and make any other necessary enquiries regarding your application with other departments and statutory organisations in relation to the application. Your personal information will be processed in line with Data Protection Legislation and we will not disclose information about you to anyone outside the Council unless the law permits or requires us to.

I understand that Disclosure of Criminal Records will be requested from the Disclosure and Barring Service and that the search is not limited by the Rehabilitation of Offenders Act. I am aware that the Council complies with the Bureau’s code of Practice in handling disclosures https://www.gov.uk/government/publications/dbs-code-of-practice Particular attention is drawn to section’s “processing an application” and “decision making process” – all licences.

The Authority is under a duty to protect the public funds it administers and to assist other agencies in the prevention and detection of crime. We may use the information provided in this form for this purpose and share this information with other bodies responsible for auditing or administering public funds.

Under Section 51(3) Local Government (Miscellaneous Provisions) Act 1976, the local authority is required to maintain a register of private hire driver licences, including the following details which are available for inspection by members of the public: The name the of the person to whom it is granted; the date on which and the period for which it is granted; if the licence has a serial number, that number. As Surrey Heath Borough Council issues dual Hackney Carriage and Private Hire Licences, the above applies to both.

The personal information you provide will be held for the duration of your licence from the date of receipt, after which it will be securely destroyed 6 years after the expiry, surrender or revocation of your final licence, in line with our retention policy (except in the event of an appeal or judicial inquiry, in which case it will be retained for as long as is required to determine these matters).

The Council’s corporate privacy notice, which includes details of the authority’s Data Protection Officer and your information Rights is available at https://www.surreyheath.gov.uk/about-council/information-and-data/privacy/licensing-privacy-policy If you believe the data we process on you is incorrect you may request this information and if necessary have it corrected or deleted. If you wish to raise a complaint you can contact our Data Protection Officer. If you believe we are not processing your data lawfully you can complain to the Information Commissioner’s Office https://ico.org.uk

	Previous Name(s)	Dates Known
Name 1
Name 2
Name 3

	Included with Submission
Medical report completed by a GMC registered doctor with access to a summary of applicants medical history, completed within the last 4 months.
Proof of right to live and work in United kingdom.
Certificate of good conduct if applicant has lived overseas for more than six months since the age of 16 obtained from the relevant embassy.
Photographic proof of identity (passport, residence permit)
Current DVLA driving licence or equivalent – detailing full current postal address
Documentary proof of National Insurance Number
Bank statement or utility bill (not credit card or mobile phone bill) showing current address issued within the last 3 months
Agree to subscribe to the Disclosure and Barring Service (DBS) Update Service
DVSA Private Hire / Hackney Carriage driving assessment pass certificate or Blue Lamp Pass Certificate or AA Drive-tech Pass Certificate
DBS check completed by Surrey Heath Borough Council issued within the last 1 month
A passport photograph, taken within the past three months (no sunglasses or head wear unless won for religious purposes)
Receipt for licence fee
Safeguarding Certificate
DVLA Check Code

PERSONAL DETAILS

DRIVING LICENCE DETAILS

EMPLOYMENT

MEDICAL HISTORY

OFFENCE HISTORY

CERTIFICATES

DECLARATION

CHECKLIST