Your details

Name

Customer name
Title

Contact

Contact details
We will contact you on this number to take payment

Business details

Are you a:

Business name


Satellite Office address

Satellite office address

Limited company registered office address

limited company registered office address

Business main contact

Contact details

Renewal details

Licence length
Upload a formal agreement from the premises owner giving permission to use the premises as a satellite office to cover the period of the licence

Management Structure

List the details of all Directors, Secretaries and Managers

List the details of all Owners and Managers.

Person 1

Name

Customer name
Title

Address

Customer address

Contact

Contact details

Other details



Person 2

Name

Customer name
Title

Address

Customer address

Contact

Contact details

Other details



Person 3

Name

Customer name
Title

Address

Customer address

Contact

Contact details

Other details



Person 4

Name

Customer name
Title

Address

Customer address

Contact

Contact details

Other details



Person 5

Name

Customer name
Title

Address

Customer address

Contact

Contact details

Other details



Additional Persons

If you need to provide details of any additional persons, please do so here

Offences and Convictions

It is a breach of conditions to not disclose any convictions or fixed penalties to Licensing Services.

Has the company been convicted of any offences since the previous Operator's Licence was granted?
This includes motoring convictions currently being investigated or charge as summonsed for any offences
Has there been any convictions recorded against any company director or secretary since the previous Operator's Licence was granted?
This includes motoring convictions currently being investigated or charge as summonsed for any offences

Declaration

I/We declare that all our information has not changed from our previous application.

I/We declare that any changes in information from our previous application have been provided to Licensing Services.

I/We declare that the replies given by me on this form are true, complete and accurate.

I/We understand that if any information given by me is false, I/We shall be liable to prosecution and that any licence obtained as a result may be revoked.

I/We understand that on the grant/receipt of my/our Private Hire Vehicle Operators Licence it is my/our responsibility to ensure that I/We fully comply with the conditions of licence at all times.


APPLICATION FEES WILL NOT BE REFUNDED

THE INFORMATION GIVEN MAY BE HELD IN MANUAL OR COMPUTERISED FORM AND WILL BE SUBJECT TO THE PROVISIONS OF THE DATA PROTECTION ACT 2018.

For more details please visit the City of Wolverhampton Council Privacy Notice page.

The City of Wolverhampton Council 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 more details please visit the City of Wolverhampton Council website and search Fair Processing Notice Data Matching.


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