Appendix

Perth and Kinross Council · 16 June 2022
Back to Licensing Committee — 16 June 2022 and its agenda

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Page 1

20301
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if; I I 030 For Of}401cialuse onl
s ,w: ' Date
5, 0311'??? received
034"030 --S PERma '
E 030c030}401}401030c031}401 -
;_'. REQUEST FOR CONSENT TO MATERIAL CHANGE
E IN CIRCUMSTANCES OR ALTERATION OF
°030 CIVIC GOVERNMENT (SCOTLAND) ACT, 1982 LICENCE
TAXIIPRIVATE HIRE DRIVER, TAXI OPERATOR, PRIVATE HIRE OPERATOR
LICENCE
PLEASE COMPLETE IN BLOCK CAPITALS
Question 1 024Licence
holder details
Licence holder name Kg 1.47;} MALL;
Licence holder '5?024UOODO§\05 Q6>C6nrr
address PéUH031
030 9H2 06w -.
Contact telephone ~.
number 030
Emailaddress
Question 2 024Licence
Details
Type of Licence held
Taxi/Private Hire Driver El
Taxi Operator [:1
Private-Hire Operator M
Licence Number
- {7H 1}) 3

Page 2

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3
Z Qu'estion'3 -024 030
034Variation Details
EE .
; Do you wish to remove
E someone from your Yes El No M Ma [:1
s licence?
5
E
g If 034yes035,please provide Surname
full details of the
person to be removed.
Do you wish to add 030
someone to your Yes D No IE Na El
licence?
If 034yes035,please provide Surname
full details of the
person to be added.
-_
Private Home Address
including postcode
_024
.024
Date and place of Date of Birth Place of Birth
birth

Page 3

§
3
E Do'es he/slhe haye any
E convictions Yes D No D
E .
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}402
S
E
E Convictions (Please
034use separate sheet if
necessary)
Has the new person (if
applicable) lived in the
UK for at least 10 Yes El No D
years?
If no, please provide a
letter from your home
country con}401rmingthat
you do not have any
convictions. 030
4. Do you have a >
change in your medical Yes [I No [21030 Na El
history?
If 034yes035please provide
details of your medical Date }401rstdiagnosed _ _/_ _/_ _ _ _
condition.
Condition
Are your receiving any medication/medical attention in connection
with this condition? Yes [:I No E]
Describe the effect this may have on your }401tnessto drive a
Taxi/Private Hire car _ _
Do you have any medical condition which would prevent you
carrying a guide dog or assistance dog in your vehicle?
Yes D No D

Page 4

§3 .
Z 5, Are you.informing the Licensing
034Department of criminal Yes El No IZl Na El
E convictions and/or driving
E offences?
S Type of criminal conviction 024
E Sentence
B
;, . Driving Offence
Points obtained
6. Are you. applying to display
, ' ' r)
advertisement/s on your vehicle. Yes 1:] No Na El
. Attach a design proof of the advertising clearly showing
where the advertising will be placed on the vehicle.
, . . , 031> Please con}401rmthat you are displaying 034PreBook Hire035signs?
H . Yes El No El 030:
7. Are you030applyingfor any other V}
amendment to your licence? . Yes M No El Na El
lf yes, please provide further ' 030V 030 ~
details. » $eé}402vr'u031}402mg0030
8. CHECKLIST .. " I > 031 Vt '
(a) Have you enclosed/mad030e'paymen'tof the £71.00
fee Yes El N/A El
(b)v Have you enclosed a design proof of the
3 advertising you wish on your vehicle Yes D N/A D
(c) If the person/s who I have added to my licence
has not lived in the UK for 10 years I have Yes E] NA |___I
enclosed a030letter from their home country "
confirming that llmy manager have/have not got
any convictions
HOW WE USE YOUR PERSONAL INFORMATION
The information provided by you will be used by Perth & Kinross Council to process your application and
thereafter to keep you informed of any updates with regard to your application or licence.

Page 5

21; .
9031 .
33 Your information will be shared with Police Scotland, Scottish Fire and Rescue Service, Planning Service and
E Environment Services in order to determine if you are a fit and proper person to hold a licence. A
g requirement for this licence is to display a site notice for 21 days which the public can view and this will
5, contain personal information which will include your name and address.
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g The Council may also check information provided by you, or information about you provided by a third
,':.031 party, with other information held by us. We may also get information from certain third parties or share
5 your information with them in order to verify its accuracy, prevent or detect crime, protect public funds or
S where required by law.
00
You should be aware that the names of individuals who hold this licence appear on a register which is
available for public inspection
I declare that the particulars given by me on this form are true. | consent to the sharing of my
personal information for the purposes set out above,
Signature of applicant/agent
Signature of applicant(s) to be removed from licence or added to licence
030 Date 030
It is an offence to make any statement in this-application which you know to be false or to
030 recklessly make any statement which is falsé in a material particular. Offences are punishable
by a fine up to £1,000. June 2019

Page 6

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Page 9

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Page 10

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B No! lltems 1 P I F ,Commenls No030030Items I P I F [Comments
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u _-- Upholstery clean and free from stains, cuts, rips, ..
u _I!- abrasive edges, securely fastened ,.
_u- _§ Carpe031tsand mats clean, intact, not excessive! worn --
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Page 11

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ix. How We Use Your Eersonal Information If you or someone you know would like a copy of this .
n .. . i . document in another language or format,'(on occasion only
H The Informatlgn proVIded by You M035be 03455dby Perth 8030 a summary of 030hedocument will be provided in lranslation),
g Kinross Count035to record details of vehicle ownership in this can be arranged by contacting
E respect of taxi tests. The information will not be disclosed the Customer Service Centre on 01738 475000
E to third parties except as described below.
E The Council may check information provided by you. or 05"035J0340034034{[U}402ff-030fff}401''f0340030M034WW«5030J03003030340309034D! _
8 information about you provided by a third party, with other 0350303MW (5" 034J90309)0340349"""0340034034034030034MU030Y0301') 03440300303030035
N information held by us, We may also get information from cusmme' 59'3034034cemr}401f030w
E certain third parties or share your information with them in 01738 475000 2035034M034«*J
5 order to verify Its accuracy: prevent or detect crime, protect Mlsgwjd/uJ031JZJPJL/030JLI;P_030nZYTpgl'}401
__ public funds or where reqUIred by law. - , H,
3 Forfurther information, please look at our website ?031K031";({030wfr?I/030Z031K031wLZ031P031JW030f)
www,pkc,goviuk/dataprotectian or email DataProtection@ 0}; Customer Service Centre .030z031é031gidycxuzmi
pkc,gov.uk or telephone 01738 477933. -
.5.IfklfL/jyué 01738 475000/
110%l}402i}401f}402i}402031}402}401}402E??igié'ré030lli}401}401liw}402}401ft}401}401}401g'}401030zk}401}401é}401'
(?EEHT030JE' EEE030MPRQEMEE030CE031JWESE)' é030r}401031llé}401iv}401 031
Customer Service Centre 01738 475000
meow: -
Jeieli chcialbys lub ktos chcialby uzyskaé kopie owego
. dokumentu w innym jezyku nii jezyk angielski lub
w innym formacie (istnieje motliwoéc uzyskania
streszczenia owego dokumentu w innym jezyku nii jezyk
angielski), Prosze kontaktowaé sie 2
Customer Service Centre 01738 475000
_ P ejeteJi si Vy, anebo n kdo. koho zn}401te.kopii lélo '
listiny v jiném jazyce anebo jiném formdlu (v n klerych _
p fpadech bude p eloZen pouze slru ny obsah listiny)
Kontaklujte prosim Customer Service Centre 01738 475000 , 030
' 031' ngivvy izeni télo poiadnvky. 2 z . . _
Ecnvl eaM mm Komy nm}401oKOI'O Eb] anaere Heo}401xcnmma
Konm 3mm noKyMeHTa Ha Apyrom HSbIKe mm a HPYI'OM
030 cpopma030re,5m moxe030reGanpOCMTb COKpauleHHyIO
Kunmo noKymeHTa ospamaumce
Customer Service Centre 01738 475000
Nam bu mhath leak fhein no neach eile as aithne dhul
lethbhreac den ph030aipearsec am an cénan no am an crulh eile
(uaireannan cha bhi ach geérr024iomradhden phaipear ri ihaotainn
ann an eadarelheangachadh). gabhaidh sea a dhéanamh le fios
a chur gu lonad Sheirbheis Theachdaichean air 01738 475000.
_ You can also send us 0 text message on 07824 £98145.
» All Council Services can offer a telephone translation facility. :
www.pkc.gov.uk (PKC Design Team - 2018781)

Page 12

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a X K} I030a
- . «xv» TaXI/Prlvate HIre Car
.3ou Nc. L Certificate of F/z030ness
Operator W
, Vehicle ' 031
Registration Mark imm_ . h
Licence No M
. Date of Issue _ ) Q- i A
Date of Expiry ZR C6
This is to certify that the above vehicie has been examined and
found to be satisfactory for use as a ai/private hire car" under
the statutory requirements prescribed; by Regulations made under
Section 45 of the Read Traffic Act 1988 and Section 20 (1) of the
Civic Government (Scotland) ACt 1982.
Note: This certificate is only valid when presented with a current '
Council Tai/Private Hire Car030licence.
Examiner on behalf of * '
Perth & Kinross Council

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