Application Details	
Private Hire Licence / Hackney Carriage Licence           (Delete as Appropriate)
	
Application Type      New      /  Renewal    /    Vehicle Change       (Delete as Appropriate)

     Existing Plate number if known:        
	
Proprietors Details	
					
First Name 	 	Surname	                		

Business Name	 	Reg No	 		
							
Current Address 	 				
		   Telephone Number		
Post Code					
							
Email Add		** An e-mail address is mandatory**	
							
Vehicle Details	
					
Vehicle Registration No  	 	Registration Date   	 		
							
Vehicle Make  	 			
							
Model  	 			
							
Colour on V5   	 	Engine Size (CC)	 		
							
Body Type  	 			
							
Wheelchair Access	Yes	No	Licensed to Carry	 	Number of Persons.       		

Meter Fitted  	Yes	No	Serial No			
							
Insurance Company  		Certificate Cover Note no     			
							
Insured Person  					
							
Valid from  		             Valid To  				
							
Testing Station  		Pass Cert No  			
							
Pass Date  		Mileage at Test date  			

							
In order to obtain a licence from SMBC	
•	I / We *have / have never been refused a licence / had a licence revoked by any authority; 
•	I / we confirm that all seats in this vehicle offer passengers a clear access & exit route, nor do seats have to be tipped forward in order to allow another passenger to exit. 	
See overleaf for Declaration

Declarations of understanding & accuracy of information	
	
By signing this application I declare that the information and facts asserted are correct to the best of my knowledge and belief.  I have read and fully understand the declarations made and I accept and understand that any false statement or omission of relevant particulars may mean that I am liable to prosecution and that any licence subsequently awarded can be revoked.  
I understand that all motor vehicles with a capacity of 2 to 8 passengers must be right hand drive and fitted with 4 doors (2 offside & 2 nearside).
I understand that Sefton Council is under a duty to protect the public funds it administers and may use the information provided on this form to detect and prevent fraud. It may also share this information with other bodies for auditing or administering public funds for these purposes
Sefton Council will use your personal information for the purpose of assessing your application and administering the licensing regime.  This information will be kept in accordance with the Data Protection Act.  In certain circumstances, Sefton Council may also share your personal information with the Police and other agencies for the purposes of the prevention and detection of crime.  Further information on how Sefton Council handles personal data is contained in a privacy policy available on www.sefton.gov.uk	
				
Signatures -		Date -	 		

Checklist:

This form should be completed in full and along with copies of the following documents e-mailed to taxiapplication@sefton.gov.uk 

-	Completed Application Form
-	Test Certificate
-	Insurance Certificate
-	V5 Certificate / Bill of Sale