APPLICATION FOR THE RENEWAL OF A HACKNEY CARRIAGE VEHICLE LICENCE Please read the Criteria for Hackney Carriage Vehicle Licence below BEFORE you completed this form. For Office Use Only Surname ____________________________________________________ Date Received ______________________ Forenames __________________________________________________ Fee _______________________________ Address _____________________________________________________ Receipt No. ________________________ _____________________________________________________ App. Complete _____________________ Postcode ____________________________________________________ Date Issued _ _______________________ Phone No. ___________________________________________________ HC No. ___________________________ Name and address of any other party involved with this vehicle* Name ______________________________________ Nature of Interest _____________________________ Address ____________________________________ ____________________________________ Postcode ___________________________________ Date of Birth _________________________________ *Continue on separate page if required. How many Hackney Carriage Vehicle Licences do you hold? _________________________________________ Have you ever been convicted in Court? Yes/No* *Delete as appropriate Give details of all convictions, motoring or otherwise OFFENCE COURT DATE PENALTY Please give full details of vehicle for which you propose to apply for renewal Plate No. Reg. No. Make and Date first Cubic Seating Colour Model Registered Capacity Capacity In accordance with the provisions of the Town Police Clauses Act 1847 and the Local Government (Miscellaneous Provisions) Act 1976. I/we make application to the Council to licence the above vehicle as a Hackney Carriage Vehicle to be used within the Borough of Castle Point. Note: Renewal application will not be accepted without the production of the following:- Current Insurance Certificate ( ) MOT Certificate (if applicable) ( ) Vehicle Registration Document ( ) Mechanical Inspection Certificate ( ) Fee £ IF ANY PERSON KNOWINGLY OR RECKLESSLY MAKES A FALSE STATEMENT OR OMITS ANY MATERIAL PARTICULAR IN GIVING INFORMATION UNDER THIS SECTION, SHALL BE GUILTY OF AN OFFENCE Signed: _____________________________________ Dated: ______________________________________ All joint proprietors to sign: ____________________________________________________________________ Licences expire annually. Licensees are reminded that it is an offence to drive or employ a driver, at any time, who does not hold a current Dual Hackney Carriage/Private Hire Driver’s Licence issued by the Council. A separate application must be made in respect of such licences. If your application is approved and all of the Council’s requirements are met you will be issued with a licence. The Council’s Licences are issued subject to conditions which you must read carefully (these are set out in the Council’s policy document which can be obtained from the Licensing Unit). Please complete and return the application form to: Castle Poing Borough Council LICENSING UNIT Council Offices Kiln Road, Benfleet Essex SS7 1TF The information supplied on this form will be held on computer Castle Point Borough Council may use this inforamtion to check other information supplied to you to the Council. The Council may from time to time disclose some of this information in accordance with the Data Protection Act 1984. If you would like a copy of this document in large print, audio tape, Braille, a different format or language please contact the Licensing Unit 01268 882416. If you would like a copy of this document in large print, audio tape, Braille, a different format or language please contact the Licensing Unit 01268 882416.