Licensing
Town Hall, Feethams
Darlington
DL1 5QT
Tel:
01325 405 888
Fax:
01325 405 983
Email:licensing@darlington.gov.uk
APPLICATION FOR RENEWAL OF LICENCE TO DRIVE
A HACKNEY CARRIAGE OR PRIVATE HIRE VEHICLE
I hereby make application to renew my Driver’s Licence Number
which expires on
to act as a driver of any Hackney Carriage/Private Hire Vehicle
licensed as such by Darlington Borough Council, subject to the consent of the proprietor and to the provision
of such Acts and Byelaws as are or may from time to time be in force in the controlled area.
Type of Licence applied for (Please tick as appropriate)
Hackney Carriage Driver Licence
Private Hire Driver Licence
Dual Licence
APPLICANT
Surname
Forenames
Any other names which you have
been known by
Address
Post Code
Telephone Number
Mobile Telephone
Email Address
Date of Birth
National Insurance No
I declare that I am, and for at least twelve months prior to the date of this application have been,
the holder of a licence (not being a provisional driving licence) under Part III of the Road Traffic Act
1972, authorising me to drive a motor car and details of which are:
DVLA Licence No
I have held a full driving licence for
Expiry Date
yrs
Type of Licence
Photo card*
Paper
* If you have a photo card licence what date does the photo card licence expire
DBC/LICENSING/Driver Renewal Application Rev 2 2011
Medical Declaration
I certify that there has been no deterioration to my health since the submission of my last medical
examination certificate and that I have not been advised by any medical practitioner or similar qualified
person or body to notify the DVLA or the Council of any medical condition that may affect my ability to
drive a motor vehicle.
Signed
Date
OR
I declare that there has been a change to my health during the period of my previous licence
I have disclosed my diagnosis to the Licensing Office prior to making this application
I have been advised by my doctor that I need to notify the DVLA about my medical condition(s)
Please declare the change to your medical health if you have not already disclosed this to the Licensing
Office.
Diagnosis/Illness
Date of Diagnosis
Doctor
Consultant
Other
1.
Medication Prescribed
2.
3.
Eg mg
1.
Dose
Eg 1 tablet 3 times per day
Frequency
Eg nighttime
2.
Dose
Frequency
Time Taken
3.
Dose
Frequency
Time Taken
Time Taken
If the medication you have been prescribed has any possible side effects which the Licensing
Office need to be aware of please state all side effects here
Is there any other information concerning your medical health that we need to be aware of
No
Yes*
*Details
Please continue on a separate sheet if necessary
Details of any endorsements of fixed penalties on your driving licence
Date of Conviction
Nature of offence or Name and Type of Sentence or order
or
fixed
penalty code
Court
or
Fixed imposed by Court or
endorsement
Penalty
fixed penalty
DBC/LICENSING/Driver Renewal Application Rev 2 2011
Details of any Cautions or Convictions.
I do solemnly and sincerely declare as follows (please tick)
I have never been convicted for any Offence or received a Caution, Reprimand or Final Warning.
I have been convicted for an offence or offences and I list below every offence for which I have
been convicted including the date of the offence, the place that the offence was committed and
the sentence imposed by the Court. I have not been convicted of any other offence.
I have received a Caution, Reprimand or Final Warning and I list below every Caution, Reprimand or
Final Warning I have received including the date, place and issuing Police Force. I have not
received any other Caution, Reprimand or Final Warning.
Date
Offence/Caution/Reprimand or Final Warning
Court/Police Force
Sentence
(If Necessary Continue On A Separate Sheet)
I declare that to the best of my knowledge and belief, the information I have given on this form is true and
correct.
If a licence is granted I agree to comply with the legislation, byelaws(if applicable) Council Policies and any
conditions attached to the licence. I understand that to give false information or make a false statement,
knowingly or recklessly, or omit any information from this form is an offence and may result in prosecution
and/or the revocation of the respective licence.
Signed
Dated
Before you hand in your application for processing please check that you have brought all the
relevant documents. This application must be accompanied by the following
DVLA or equivalent driving licence (original) (both photo card and paper licence)*
The correct fee **
Where a Medical Certificate is due – it must be completed by your own GP or Registered Medical
Practitioner, or by another GP who has access to your full medical records, and must conform to Group II
Standards.


Age 45 to 65 years
Age 65 years or more
5 yearly intervals
12 monthly intervals
Where a DBS check is due the identification and documents you produce must be original or certified copies. Your proof
of address can include a Utility Bill, Council Tax,or Bank Statement providing the documents are not older than 3
months.
*
**
***
where an application has been paid for by cheque it will not be considered to be properly made until the cheque has cleared
Should you have a DVLA photo card driving licence please check the expiry date to ensure that it is still valid. The valid date
appears at 4b on the card. Where this has expired or is due to expire you should apply to renew this with the DVLA. The
Council will be unable to renew your driver licence where your DVLA licence has expired
Not more than 3 months old
How We Collect and Use Information
The information collected, on this form and from supporting evidence, by Darlington Borough Council will be used to process your
application. The information may be passed to other Enforcement Agencies as permitted by law.
We may check information provided by you, or information about you provided by a third party, with other information held by us. We
may also get information from certain third parties, or give information to them to check the accuracy of information, to prevent or detect
crime, or to protect public funds in other ways, as permitted by law. These third parties include Government Departments and local
authorities.
We will not disclose information about you to anyone outside Darlington Borough Council nor use information about you for other
purposes unless the law permits us to.
Darlington Borough Council is the Data Controller for the purposes of the Data Protection Act 1998. If you want to know more about
what information we have about you, or the way we use your information, you can contact the Council’s Data Control Officer, The Town
Hall, Feethams, Darlington
DBC/LICENSING/Driver Renewal Application Rev 2 2011
PROPOSED OFFER OF EMPLOYMENT
This form must be completed and signed by you and your employer(s)
Part 1 - Private Hire Drivers and Dual Drivers
I confirm that if I am granted a licence to drive a private hire vehicle I shall be working through
Name of Licensed Private Hire Operator
Business Address
(the Private Hire Operator must complete Part
1a of this form)
Also, I shall be driving a vehicle belonging to myself

or I shall be driving for
Name and Address of Vehicle Proprietor
(Complete ONLY if you will not be providing the
vehicle, the vehicle proprietor providing the
vehicle must also complete Part 3 of this form)
Part 1a - Private Hire Operator
I confirm that if
[Insert name of applicant]
is granted a licence
to drive a private hire vehicle I will employ him/her to drive through my company
Name of Licensed Private Hire Operator
Signature of Private Hire Operator
Date
Part 2 - Hackney Carriage Drivers and Dual Drivers
I confirm that if I am granted a licence to drive a hackney carriage vehicle
I will be self employed and will be providing my own vehicle/working alone 
or I shall be driving for
Name and Address of Vehicle Proprietor
(Complete ONLY if you will not be providing the
vehicle, the vehicle proprietor providing the
vehicle must also complete Part 3 of this form)
______________________________________________________________________________
Part 3 - Vehicle Proprietor
I confirm that if
[Insert name of applicant]
is granted a licence
to drive, I will provide him/her a vehicle to use during the course of his/her employment
Name of Vehicle Proprietor
Signature of Proprietor
Date
DBC/LICENSING/Driver Renewal Application Rev 2 2011