East Northamptonshire Council

Confidential

Please return this form to: Licensing Administrator Environmental Services East Northamptonshire Council Cedar Drive Thrapston, Northamptonshire NN14 4LZ. Phone: 01832 742057 Fax: 01832 742192 DX: 701611 Thrapston E-mail: [email protected] Website: www.east-northamptonshire.gov.uk

Section 55 Local Government (Miscellaneous Provisions) Act 1976

Application for a Licence to Act as an Operator of Private Hire Vehicles

Please phone us on 01832 742057 or 742067 to make an appointment for the Criminal Records Bureau interview. If you currently hold an Enhanced CRB Disclosure, it needs to be dated within the last month for us to use with this application.

I apply for a licence permitted me to Operate Private Hire Vehicles

Last name:

First name (or names):

Address and postcode:

Phone number (s) :

Date of birth:

Place of birth:

EH/Licensing/Drivers/Driver applform 3 June 2008 Please bring in the following: If you do not provide everything we ask for, we will have to return your application to you.  Your application fee and the Criminal Records Bureau application  fee. Please make your cheque payable to ‘East Northamptonshire Council’, the council can not accept cash payments. Please see charges and fees for amount payable.   The completed Criminal Records Bureau Enhanced Disclosure application form

For our use only:

Application form checked:

Application fee received:

Criminal Records Bureau Enhanced Disclosure application form

Licence Issued:

INCOME CODE: CKN0039673

EH/Licensing/Drivers/Driver applform 3 June 2008 Please answer the following questions.

1 Operators Trading Name

Give the address from which the Private Hire Business will be carried out, if different from the above

Where is the address the Private Hire Vehicle Register will be available for examination

Are you employer or the employee

2 Please tell us about the nature of your business

What is the name and address of your employer, or what is the trading name of your employer?

Please continue on separate sheet if necessary

Address of Reason for Employer L Please give the nature of your e employment over the past three years, a name and address of employer and v reason for leaving i n Please continue on separate sheet if g necessary

Are you involved in the business of Private Hire?

If so, please give the length of time in business and the number of vehicles used

EH/Licensing/Drivers/Driver applform 3 June 2008 Have you ever been involved in the Private Hire Business? Yes  No  If Yes, please tell us:

(a) The name and place where the business was carried out

(b) What was the reason for stopping your involvement with the business

Have you or any Company operated by you, or if a Company any official of that Company, held a Private Hire Operator’s Licence or Hackney Yes  No  Carriage Vehicle Licence?

If Yes, please tell us which, and

(a) Type of Licence

(b) Date of application

(c) If suspended or revoked, the date and reason given by the Licensing Authority

(d) Who were the Licensing Authority concerned

Are you the holder of a current Private Hire Vehicle or Hackney Carriage Yes  No  Driver’s Licence?

If yes, please give us:

(a) The number

(b) The date of issue

(c) Who were the Issuing Authority

EH/Licensing/Drivers/Driver applform 3 June 2008 Has any application made by you for the grant of a Licence as above ever Yes  No  been refused or, if granted, been suspended or revoked.

If Yes, please tell us why:

3. Please tell us about ALL offences in connection with a motor vehicle, its Licensing or Insurance, for which you have been convicted.

Please tell us the penalties imposed and include endorsements.

You can continue on a separate sheet, if necessary

4. Please give details of all Fixed Penalty Notices you have ever received

5. Please tell us about ALL criminal offences for which you have been convicted.

Please include any fine or sentence imposed

You can continue on a separate sheet , if necessary

Please tell us about ALL Cautions you have received.

6. Have you ever received an Anti Social Yes  No  Behaviour Order

If Yes, please tell us when:

EH/Licensing/Drivers/Driver applform 3 June 2008 9 Have you ever been convicted of any Yes  No  offence in relation to a company?

If Yes, please tell us the details

Please note that you may need planning permission if you intend using part of your house for business purposes. You should therefore consult Planning Services, East Northamptonshire Council, East Northamptonshire House, Cedar Drive, Thrapston, Northamptonshire NN14 4LZ (telephone 01832 742000)

If you are a Housing Association tenant, you may need the Landlord’s permission to operate a business from your home.

Declaration:

EH/Licensing/Drivers/Driver applform 3 June 2008 I declare that, to the best of my knowledge and belief, the statements made in this application are true and correct and that I am in a position to fulfil, as a Private Hire Operator, all reasonable obligations to the public. I realise that, if for the purpose of obtaining a Licence, I make any false statement or omit any material particular, I may be liable to prosecution.

I further declare that:

* 1. I am not in partnership with any other person

* 2. I am in partnership with : ______

Of ______

______

Who will complete a separate application.

* Please delete as necessary

Your signature:

Note: Please read the terms and conditions for operators of Private Hire Vehicles

EH/Licensing/Drivers/Driver applform 3 June 2008