LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS) ACT 1976
TOWN POLICE CLAUSES ACT
For Office use only
Date App. Rec’d _____________
Use page 4 for payment details
VEHICLE – New Application
Application for a New Hackney Carriage or Private Vehicle Licence
Before submitting an application you should read Stroud District Council’s document ‘Taxi and
Private Hire Information, Policy and Conditions’ available on our website www.stroud.gov.uk.
The vehicle must be inspected by a Licensing Officer at Stroud District Council Offices, Ebley Mill
before the application can be determined. Please use the contact details at the end of this form to
book an appointment and for further information:
1. Applicant Details
Title
Mr/Mrs/Miss/Ms delete as appropriate or specify if other:……………………...............
Surname:
………………………………Forenames:… ………………………………………….…..…
Address:
…………………………………………………………………………………………………..
…………………………………………………………………….… Postcode: ………………………………
Telephone Numbers - please tick if the number can be made available to the public:
Home: ………………………………...
Business:……..……………………….….
Mobile: ……………………..………..…
Email Address: ……………………………………..…
2. Type of Licence
Are you applying for:
Hackney Carriage Vehicle
(Go to section 4)
Private Hire Vehicle
(Go to section 3)
3. Private Hire Details – to be completed by applicant for private hire vehicle only
Do you hold your own private hire operators licence?
Yes
No
If No give the name and address of the private hire operator that manages your bookings
……………………………………………………………………………………………………………………
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4. Details of Vehicle
Registration Number…………………………………… Colour……………………………………………..
Make……………………………………………
Model……………………………………………...
Date of first registration……………………………….
Number of doors…………………………………
Passenger seating capacity……………………….….. Engine capacity………………………………….
(not including driver)
Has the vehicle ever been substantially repaired and/or accident damaged?
(Insurance Write-off)
Yes
No
5. Details of Meter
NB Hackney carriage vehicles must have a meter fitted. It is optional for private hire vehicles
Do you have a meter fitted?
Yes
No
Meter make/model ……………………..
Serial No. …………………………………….….
Is the meter sealed? Yes
Name of meter fitter …………………………….
No
Date of Purchase … ……………………
6. Insurance Details
Name of company insuring vehicle……………………………………………………………………………
Insurance policy number………………………………………..… Type of cover………………………….
Cover note number ……………………………………………….. Expiry Date …………………………..
7. Third Party Interest eg Lease Company, Co-Owner
Is the registration document in your name?
Yes
No
If No, state the full name and addresses of other parties.
(1)
Surname:…………………………………………………………………………………………….…
Forenames: ……………………….…………………………………………………………………...
Address: …………………………………………………………………………………………….….
……………………………………………………………………………………………………….…..
Postcode: …………………………….. Home Telephone Number: ………………………………..
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8. Declaration

I certify the statements made in this application are true to the best of my knowledge and
belief.
On grant of a licence I undertake to comply with Stroud District Council’s byelaws, policy
and conditions for hackney carriage and private hire licensing.
I declare that the vehicle will be insured for Hackney Carriage or Private Hire purposes, as
relevant, whilst the licence is in force.
I consent to Stroud District Council retaining and processing my personal data in
accordance with the statements below.



NB - Making a false statement is an offence and may lead to revocation of the licence or the
applicant liable to prosecution
Signed …………………………………………………….…
Date ……………………………......….
Stroud District Council is a registered Data Controller for the purposes of the Data Protection Act 1998. We will process your personal
data in accordance with that Act. We will use the information you have provided on this application form to assess the suitability of the
vehicle as a hackney carriage or for private hire and for administration and management purposes. We may disclose the information
to external agencies for crime prevention purposes and statistical analysis. If your application is unsuccessful, we will keep your
information for a reasonable period in accordance with legal requirements and for administration purposes.
This authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on
this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or
administering public funds for these purposes. For further information, see Stroud District Councils website www.stroud.gov.uk using
the following link http://www.stroud.gov.uk/docs/democ/data_matching.asp or contact Michael Nadin in Internal Audit by email on:
michael.nadin@stroud.gov.uk or by telephone on: 01453 754122
9. Application Requirements
This application must be accompanied by the following original documents:

Vehicle Registration Document

Certificate of Insurance

Ministry of Transport Test Certificate (if vehicle is over one year old)

Council Vehicle Test Certificate

Meter Certificate (if applicable)
The vehicle must be fitted with:

Fire Extinguisher – all vehicles

Meter – hackney carriage only

Roof Sign – hackney carriage only
10. Fees



Application Fee of £150 (including plate)
Plate deposit of £25 (refundable on return of plate)
Bracket £11 (if required)
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LICENSING SECTION CONTACT DETAILS
Licensing Section, Stroud District Council, Ebley Mill, Westward Road, Stroud, GL5 4UB
Tel 01453 754440 Fax 01453 754963 Email licensing@stroud.gov.uk Web www.stroud.gov.uk
For Office Use Only – Payments
Reference
New Application Plate Number
Amount
£150
Plate Deposit Plate Number
£25
Bracket Plate Number
£11
Updated September 2015
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Initials
Date