Milton Keynes Council, Synergy Park, Chesney Wold, Bleak Hall
Office Use Only
PH FLARE NO: / HC FLARE NO: / TEMP FLARE NO:TAXI LICENSING SERVICE
Milton Keynes Council, Synergy Park, Chesney Wold, Bleak Hall,
Milton Keynes, MK6 1LY
Documentation Update Application Form
FIRST NAME:SURNAME:
LICENCE: / PRIVATE HIRE / HACKNEY CARRIAGE
BADGE NO:
TYPE OF DOCUMENTATION SUBMITTED
Right to Work / DVLA / Medical
DOCUMENT
PASSPORT / UK / EU / Non EU
PROOF OF RIGHT TO WORK IN UK / UK PASSPORT
EU PASSPORT
EU IDENTITY CARD
UK BIRTH CERTIFICATE
RESIDENCE PERMIT
VISA
TRAVEL DOCUMENT
WORK PERMIT
PASSPORT NUMBER
(ref number of Right to Work documentation)
RIGHT TO WORK EXPIRY DATE
NATIONALITY
DVLA LICENCE / YES
DVLA LICENCE NUMBER
EXPIRY DATE
MEDICAL PROVIDED / YES
MEDICAL ISSUE DATE
DECLARATION
IMPORTANT! GUIDANCE NOTE: Please read the following statements carefully and ensure that you understand them. You should tick the relevant boxes to confirm that you have read and understood the matters that will apply to you. If you do not tick these boxes and confirm agreement to each statement we will not accept and process your application. If you do not wish to agree to these statements and believe the Council should still consider granting you a licence you must first write to the Council and explain why your refusal to consent these statements does not prevent you from being considered fit and proper.
Consent to copy and keep documents
I confirm that the Council may take copies of any, and all, documents deemed necessary and as requested by the Council as may be provided by me now or later, in order for the determination of my application and understand that the Council will retain copies of these documents for the duration of any period in which I am licensed, including all future renewals and upon the expiry, surrender or lapse of any licence granted to me only for as long as necessary
or in line with Council retention policies.
Declaration of convictions
I hereby declare that I have listed all my previous convictions, cautions, driving endorsements, penalty notices, civil sanctions and any pending matter of the same and will inform the Council immediately should I be convicted, cautioned, receive a driving endorsement, penalty notice, civil sanction or become aware of any pending matter of the same after the date of my application and before determination by the Council or at any time after I am licensed. I understand that failure to do so may lead to prosecution under Section 57 of the Local Government (Miscellaneous Provisions) Act 1976 and the refusal of my application.
Declaration to notify Police that I am a licensed Hackney Carriage or Private Hire Driver
I understand that being a licensed Hackney Carriage or Private Hire Driver is a notifiable occupation and if I am arrested for or convicted of any offence after the grant of a license to me I will notify the arresting or investigating officer that I am licensed as a Hackney Carriage or Private Hire driver. This information will be disclosed to the Council and I agree that my license may be suspended immediately should the Council consider there to be an immediate public safety risk.
Consent to Police to share my data with the Council
Where I am being investigated for any criminal offence I consent, as the data subject, to the investigating police force to disclose any and all information and documentation obtained in the course of that investigation to Milton Keynes Council Taxi Licensing services for the purposes of determining my fitness to be granted or to continue to hold a license.
Consent to the publication and sharing of my personal information
I understand that the Council are required to keep public registers of licensed drivers and may allow members of the public to inspect these registers at the Council offices or by publishing this information on the Council website. Such information will be limited to my name, my licence number and the grant and expiry date of my licence. I also understand that the Council may share my data with other Council departments and other enforcement agencies in order to prevent and detect fraud or crime.
I understand the Policies, conditions, rules and regulations that will apply to me
I have read and understood the Council’s Statement of Taxi Licensing Policy and the conditions published in that Policy that will be attached to my licence should it be granted and undertake to comply with the relevant legislation, byelaws, Council Policies and any conditions attached to the grant of such licence. I understand that the Councils Policy and conditions may change after I am granted a licence and will be informed of this by publication of a notice on the Council’s website.
Declaration that I have understood and answered all questions truthfully and honestly
I have read and fully understand the above information and I declare that to the best of my knowledge and belief the information provided and the statements I have made, on this form are true and correct. I understand that to provide false information or make a false statement, knowingly or recklessly, or omit any information from this application is an offence and may result in prosecution and/or the revocation of the respective licence.
I, the above named applicant, confirm that I have read all of the above statements and by ticking the relevant adjacent boxes and by signing below, confirm my agreement to each statement, and request that the Council consider granting me the licence(s) requested:
Signed: ______Dated ______