Application for a private hire
vehicle operator’s licence
Breckland Council, Elizabeth House, Walpole Loke, Dereham, Norfolk, NR19 1EE
All applicants must complete the Statutory Declaration. Each individual must complete their own form –
please ask if you need further copies. This will include company directors, secretaries and partners.
All applications must be supported by a fee of £144.45.
Please read fully these notes before filling in this application, and then complete only the parts of the form
which are applicable, using BLOCK CAPITALS.
PART “A” to be completed in all cases.
PART “B” applies only where the applicant is a sole proprietor.
PART “C” applies to Company applications, other than sole proprietorship or partnership.
PART “D” applies only to partnership applications.
DECLARATION TO BE SIGNED IN ALL CASES BY ALL APPLICANTS
Part A – To be completed in all cases
Please write in BLOCK LETTERS
1.
Trading name under which the Private Hire business will be operated:
...................................................................................................................................................................
2.
Operating address:
...................................................................................................................................................................
...................................................................................................................................................................
Postcode:
...............................................................................................................................
Telephone number:
...............................................................................................................................
3.
Details of Private Hire Vehicles to be operated:
Make and Type
If already licensed give LIcence
Plate Number
Registration Number
If more than three vehicles please add a separate sheet.
4.
Do you have or intend to have a waiting room for members of the public at the operating premises?
Yes
5.
No
Please give names and badge number of all drivers who are employed:
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
6.
Please provide the telephone number for public telephone bookings including:
Mobiles
Telephone numbers
Freephones
Email addresses
Part B – Sole Proprietors
7.
8.
Please give your name, address, date of birth, telephone number and email address:
Full name:
..................................................
Maiden name:
...........................................
Address:
................................................................................................................................
...................................................................................
Postcode:
..........................................
Date and place of
birth:
.................................................
Telephone
number:
..........................................
Email address:
..................................................
Mobile number:
..........................................
Has any previous application for an Operator’s Licence been made by you or on your behalf?
Yes
No
If you hold or have held an Operator’s Licence, state:
(a)
Licence number:
............................................................................................
(b)
Name of issuing Authority: ............................................................................................
9.
Has any operator’s licence held by you been revoked or suspended?
Yes
No
If yes, give
details
...............................................................................
Part C – Company Applications
10.
If you propose to operate vehicles as a company, please give the name, addrss and date of birth of each
Director and Company Secretary along with telephone number and email address:
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
11.
Has any previous application been made for an Operator’s Licence by the company?
Yes
12.
No
If an operator’s licence is currently held, state:
(a)
Licence number:
.............................................................................................................
(b)
Name of Issuing Authority:
.............................................................................................................
Has any previous Operator’s licence held by the company or by a Director of Secretary of the Company
been revoked or suspended?
Yes
No
If yes, give
details
...............................................................................
Part D – Partnership Applications
13.
If you propose to operate vehicles in a partnership with another person please give the name, address
and date of birth of each partner along with telephone number and email address:
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
14.
Has any previous application been made for an operator’s licence by you or any of your partners?
Yes
15.
No
If an operator’s licence is currently held, state:
(a)
Licence number:
.............................................................................................................
(b)
Name of Issuing Authority:
.............................................................................................................
Has any previous operator’s licence held by you or any of your partners been refused, revoked or
suspended? (If YES, give details)
...................................................................................................................................................................
...................................................................................................................................................................
Operator’s Licence
Declaration to be signed in all cases
by all applicants
Breckland Council, Elizabeth House, Walpole Loke, Dereham, Norfolk, NR19 1EE
All named applicants must complete their own individual declaration. Please ask if you require more
forms.
I (full name),
Of (address)
Date of Birth
1.
2.
state:
I have never been convicted for any offence, received a Caution or fixed penalty notice:
(please
tick) OR
I have been convicted for an offence or offences, received a caution or fixed penalty notice and I list
below every offence for which I have been convicted.
(Please list only unspent convictions. See notes on reverse as to when a conviction becomes spent)
Date and place
offence committed
3.
4.
Court which dealt with
the matter (type of Court
and town) or offence
code
Date of
Court
hearing
Date sentence
imposed (if
different from
date of hearing)
Sentence imposed
I have matters pending
(Please provide details on a separate sheet)
Do you have the right to work in the UK? Yes
No
NB: All applicants will be required to produce documentation (see attached list) to prove that they
have the legal right to work in the UK in accordance with the Immigration Act 2016.
Statutory Declaration:
DECLARATION TO BE SIGNED IN ALL CASES
I declare that I have read and understood the notes contained in this form and in the Council’s Guidance
Notes. I understand that I may be liable to prosecution if I have knowingly or recklessly made a false
statement or have omitted any relevant material.
If your licence application is accepted and you commence work and you currently receive or have an ongoing
claim for Housing Benefit or Council Tax Benefit, you must notify Breckland Council as this may affect your
claim.
Signed:
.............................................................
Date:
...................................
Explanatory notes on the Rehabilitation of Offenders Act 1974
The Rehabilitation of Offenders Act 1974 provides that convictions for criminal offences are to be regarded as
‘spent’ for certain purposes after a certain lapse of time. However all criminal convictions are relevant for
hackney carriage and private hire licensing purposes and must be declared. The Council will consider the
offence committed and the time elapsed since conviction for that offence.
Custodial sentence/disposal
Buffer period for adults (18 and
over at the time of conviction or
the time the disposal is
administered). This applies
from the end date of the
sentence (including the licence
period).
Buffer period for young people
(under 18 at the time of
conviction or the time the
disposal is administered). This
applies from the end date of the
sentence (including the licence
period).
Custodial sentence of over 4
years, or a public protection
sentence
Never spent
Never spent
Custodial sentence of over 30
months (2 ½ years) and up to and
including 48 months (4 years)
7 years
3½ years
Custodial sentence of over 6
months and up to and including
30 months (2½ years)
4 years
2 years
Custodial sentence of 6 months
or less
2 years
18 months
Community order or youth
rehabilitation order
1 year
6 months
Non custodial sentence/disposal
Rehabilitation period for adults
(18 and over at the time of
conviction or the time the
disposal is administered).
Rehabilitation period for young
people (under 18 at the time of
conviction or the time the
disposal is administered)
Fine
1 year
6 months
Conditional discharge
Period of the order
Period of the order
Absolute discharge
None
None
Conditional caution and youth
conditional caution
3 months or when the caution
ceases to have effect if earlier
3 months
Simple caution, youth caution
Spent immediately
Spent immediately
Compensation order
On the discharge of the order (i.e.
when it is paid in full)
On the discharge of the order (i.e.
when it is paid in full)
Binding over order
Period of the order
Period of the order
Attendance centre order
Period of the order
Period of the order
Hospital order (with or without a
restriction order)
Period of the order
Period of the order
Referral order
Not available for adults
Period of the order
Reparation order
Not available for adults
None
The periods of time which must elapse before the conviction becomes spent vary considerably according to
the nature of the offence and other circumstances. The rehabilitation period may be extended by the
commission of a further offence during the rehabilitation period. The summarised provisions here are intended
only as a general guide. Further guidance on may be obtained from the Home Office publication ‘Guidance on
the Rehabilitation of Offenders Act 1974’, from a solicitor or the Citizens Advice Bureau.
APPLICANTS SHOULD NOTE THAT TO MAKE A FALSE STATUTORY DECLARATION IS A SERIOUS
CRIMINAL OFFENCE, PUNISHABLE UPON CONVICTION BY IMPRISONMENT AND / OR A FINE. THIS
STATUTORY DECLARATION MAY BE FORWARDED TO THE POLICE FOR EXAMINATION.
Right To Work Documentation Required
How to pay
Breckland Council, Elizabeth House, Walpole Loke, Dereham, Norfolk, NR19 1EE
By paying by debit card or credit card we can process your application more quickly.
To pay by card please complete and return this form to:
Licensing Payment, Breckland Council, Elizabeth House, Walpole Loke, Dereham, Norfolk, NR19 1EE
Please note a 1.4% surcharge will be applied if paying by credit card
This form will be destroyed once the card has been debited.
Debit/Credit card details
Driver’s badge number (if known): ...........................................................................................................
Applicant’s name:
...........................................................................................................
Applicant’s address:
...........................................................................................................
...........................................................................................................
Postcode:
..................................................................................
Cardholder’s name:
...........................................................................................................
Cardholder’s telephone number:
...........................................................................................................
Cardholder’s email address:
...........................................................................................................
Cardholder’s address:
...........................................................................................................
...........................................................................................................
Postcode:
Amount to debit:
..................................................................................
£……………………………… + 1.4% surcharge if paying by credit card
Card number:
Valid from
/
Expires end
/
Security number
What is the Security Number?
Card issue number*
*Maestro/Cirrus only
Cardholder’s signature:
...................................................
Other methods of payment
Cheques made payable to Breckland Council
Date:
............................................