Private Hire Driver Application Pack

1 of 2

MAYOR OF LONDON

Application to become a Licensed London Private Hire Driver

Dear Applicant

Please detach and read before completing your application

Thank you for considering embarking on a career as a licensed London Private Hire driver. Enclosed within this pack you will find the following:-

Transport for London

London Taxi and Private Hire

PHV/203 V4, 11,2011

• An application form (PHV/203)• A medical form (TPH/204)

• Pre addressed envelope• TMG CRB – Introductory Letter

How Do I Apply? In order to apply you need to complete both the application and medical form (unless exempt) in full using black ink. Please ensure you have provided copies of all mandatory documentation. A checklist is provided as part of the application form to help.If you require an application in a larger font size, please call 0845 602 7000

Criminal Record CheckAs part of the licensing approval process, TfL requires all applicants to undertake an ‘enhanced’ criminal records check from the Criminal Records Bureau (CRB). This process is carried out by TfL’s Service Provider - TMG CRB.In the majority of circumstances, in order to complete the PHV/203 application form you will need to provide a CRB reference or disclosure number. You will need to make your application for a criminal records check via TMG CRB prior to making this application. Details of the process to follow can be found in the enclosed information sheet entitled ‘TMG CRB – Introductory Letter’. There are circumstances when an application is not required. Details can be found in the PHV/203 application form.

Topographical AssessmentUnless exempt you will also be required to undergo a topographical skills assessment prior to making this application. You should contact one of the accredited assessment centres to make arrangements. Details of the available exemptions can be found on the PHV/203 application form. For a list of Assessment Centres please go online to:-http://www.tfl.gov.uk/businessandpartners/taxiandprivatehire/1350.aspxThe topographical assessment requires the following range of skills to be demonstrated:Map reading ability – how to use a map, index and grid referenceRoute selection (local, intermediate & long distance) – ability to identify and plan a route (or routes) beyond your local area but within London, from your local area but within London and from your local area to points outside London. General topography – awareness of general geography of London, major arterial roads and locations beyond London (e.g. airports, towns, cities etc)You will be required to pay for your topographical assessment. Costs may vary from one centre to another. Fees are to be paid to the assessor. Transport for London (TfL) accepts no liability to pay this fee.

2 of 2

Medical FitnessTfL needs to be satisfied that all licensed London Taxi and Private Hire drivers are medically fit. In assessing an individual’s medical fitness, TfL applies the standards required for a DVLA Group 2 licence.The Medical Declaration form (TPH/204) should be taken to a registered medical practitioner who has access to your full medical history, typically your GP, for completion. If it is not completed by someone who has access to your full medical history, this could lead to delays in processing your application.This medical report cannot be issued free of charge as part of the National Health Service. You must pay the medical practitioner’s fee, unless other arrangements have been made. TfL accepts no liability to pay it.If you possess a valid DVLA Group 2 licence or are actively studying the Knowledge (and under 45 years of age), or already licensed by TfL as a MHC (‘taxi’) driver, you do not need to submit a completed Medical Declaration as you are deemed ‘exempt’.

How will my application be assessed?In order for TfL to consider whether you are ‘fit and proper’ to be licensed, your application and associated documentation will be fully assessed by our Licensing Team. For information on the decision making process and the relevant policy please refer to TfL’s licensing guidelines. This can be found at www.tfl.gov.uk/tph by selecting the section entitled ‘Publications’. It is recommended that you review this document on a regular basis as it is updated.

Where do I send my completed application? You can either post it to us using the pre addressed envelope or use the Check and Send service provided by the Post Office® on behalf of London Taxi and Private Hire (LTPH). LTPH recommends the use of the Post Office® Check and Send service as it has proven to reduce the number of unnecessary errors and omissions made in the applications process. This leads to delays and understandable frustrations for applicants.

Post Office® ‘Check and Send’ Service Please Note: Not all Post Offices will offer the ‘Check and Send’ service. For your nearest Post Office® branch offering this service please use: http://www.postoffice.co.uk/portaVpo/finderFor a handling charge of £7.15, the Post Office® will:

• Ensure the application has been completed correctly with all supporting documentation enclosed;• Take your application fee on behalf of TfL and provide you with a receipt; and• Send your application directly to LTPH, please note postage is additional.

Please note original documents and clear photocopies will be needed. Further information is available at www.tfl.gov.uk/tph/postoffice

How much will my application cost?There are three elements to the total payment of your application.

1. CRB disclosure application - To be paid to TMG CRB prior to application (See ‘TMG CRB - Introductory Letter’)

2. Licence application fee (non refundable) - £1573. Grant of licence fee - £105

Total: £262 (Full amount payable. See Section H of PHV/203 form)Payments can be made via credit or debit card by completing the appropriate section in the application form. Other payment options are available via the Post Office® ‘Check and Send’ service. These include payments by postal order and cash. The Post Office® will also accept payments by all major credit and debit cards (except Mastercard).

MAYOR OF LONDON1 of 6

A - Personal Details

Please attach a recent colour, passport-sized photograph of yourself here

PHV/203London Private Hire Driver Licensing Application Form

For LTPH use only

PHD/



Mandatory Requirements

Application Checklist

A fully completed application form PHV/203

A fully completed Medical Declaration TPH/204 completed by your GP unless you are exempt from doing so. If you are exempt, please tick this box

A recent clear colour passport sized photograph

A clear and legible photocopy of the front & back of your DVLA photocard and counterpart licencePlease note: EEA state licence holders must provide a copy of the front & back of licence and GB counterpart which must display your current address

CRB Reference or Disclosure details - see Section C

A clear and legible photocopy of UK/EEA passport; OR

If you are a non UK/EEA passport holder - please refer to Section D to confirm documentation needed

Where applicable:TPH/205 & ‘Certificate of Good Conduct’ - see Section D

(a) Are you at least 21 years of age?

(b) Have you a UK or EEA state driving licence for at least 3 years? (less any periods of disqualification)?

(c) Have applied for enhanced CRB disclosure or meet scenarios in ‘C2’

(d) Do you have the right to work in the UK?

You must answer ‘Yes’ to all of the above questions to meet the minimum requirements for licensing.

Yes No

Yes No

Yes

Yes

No

No

To submit a complete application, please ensure you have provided:

A signed declaration in Section G

Full payment to cover the cost of your application and grant of licence fee - Section H

A copy of Topographical Skills Certificate

Failure to provide any mandatory information will result in an incomplete application and may lead to delays in your application being processed. If you require further information: Please call 0845 602 7000 or visit our website - www.tfl.gov.uk/tphPLEASE COMPLETE FORM USING BLACK INK.

A1

A2

A3

A4

A5

Surname

Forename(s)

Date of Birth

Gender

Title

D D M M Y Y Y Y

Male Female

MrOther (Please specify) ..............................

Mrs Miss Ms

A6

A7

A8

Daytime telephone number

Mobile telephone number

E-mail address

2 of 6

C - CRB Reference Number

Unless a scenario in ‘C2’ applies, you cannot submit your licensing application until you have made an application for a CRB disclosure with TMG CRBFor information on how to obtain the CRB details needed to complete this application form, please see the TMG CRB ‘Introductory Letter’.

C1 Please state your CRB reference number below (please 4 one option only):

If you completed an on-line CRB application, please state your ‘E’ number:

If you completed a paper CRB application, please state your ‘F’ number:

If you have already been issued with a CRB disclosure please state the disclosure number:

As part of the licensing approval process, TfL requests that all applicants undertake an ‘enhanced’ criminal records check from the Criminal Records Bureau (CRB). This process is carried out by TfL’s Service Provider - TMG CRB

C2 You are not required to provide a CRB disclosure in the following scenarios (please 4 which applies):

You are licensed by TfL as a Taxi/MHC driver and have undertaken a CRB check within the last 3 years

You are studying the Knowledge of London and have undertaken a CRB check within the last 3 years

You can provide an enhanced CRB disclosure that has been issued within the last 3 months for LTPH or another TfL department.You will need to provide a copy of any disclosure that was issued to you in relation to an application for another TfL Department.CRB Disclosures for other registered bodies cannot be accepted.

E

F

Please Note:You must complete C1, unless you fall into one of the scenarios in C2.

Please Note:All selections in C2 will be verified. Should your circumstances not meet the scenario referred to, you will need to undertake an enhanced criminal records check through TMG CRB.This will delay the processing of your application.

A - Personal Details continued...

A9 Current address

Postcode House number

Rest of address

Yes NoA10 Is the above address on your driving licence?

(If ‘No’, your application cannot proceed)

Yes NoA11 Have you been previously known by any other names?

Please complete questions A12 - A15

A12

A13

Previous surname name

Previous forename(s)

A14 Previous titleMrOther (Please specify) ........................................

Mrs Miss Ms

A15 Date you ceased to be known by this name(s)?

D D M M Y Y Y Y

B - Driving Licence Details

B1

B2

What is your DVLA driving licence number?

What is your EEA state driving licence number (if applicable)

B3 What is the date your full driving licence was first issued?

A photocopy of your DVLA licence is required along with the counterpart.An EEA state licence holder must provide a copy of their licence AND the GB counterpart.All other licences will not be accepted.

D D M M Y Y Y Y

3 of 6

E - Topographical Skills

E1 Have you provided a topographical skills assessment certificate with this application?

F - Other Information

F1 Are you currently licensed by TfL as a Taxi/MHC driver, or are you currently studying the Knowledge or have you been previously licensed as a PHV driver?

Yes NoPlease complete question F2

F2 What is your licence type and number?Taxi badge number:

Knowledge reference number:

PHV driver licence number:

F3 Have you had an application for, or a PHV/Taxi licence refused, revoked or suspended in the last 3 years by this or any other licensing authority?

Yes NoI have been previously licensed as a London PHV driver and have completed a topographical skills assessment (please provide copy)

I am a licensed London Taxi/MHC driverI hold a recognised relevant vocational driving qualification (NVQ or equivalent)Please enclose a copy of your certificateI am a professional tourist guide affiliated to:

(organisation name)

Please enclose a copy of your certificate

D - Leave Status - Right to take Employment

D1 What is your country of birth?

Please note:If you are the holder of a non UK/EEA passport you must submit the following with your application:A copy of the stamp/residence permit within your passport (including pages with your details), your Travel document, biometric card (both sides) and/or relevant UK Border Agency document/letter confirming your leave status and right to take employmentIn addition, a copy of an official document issued by a government agency stating permanent national insurance number and your name (such as letter issued by Inland Revenue, DWP, Jobcentre Plus etc) will also need to be enclosed with your application.

D2 Please tick below to confirm your nationality and/or leave status in the UK (please 4 one option only).

I am a UK/EEA national (You must submit a clear and legible photocopy of your UK/EEA passport or UK birth certificate)I have been granted asylum/refugee statusI am awaiting a decision on an application to be granted asylum/refugee statusI have been granted indefinite leave to remain in the UKI am awaiting a decision on an application for leave in the UKI have limited leave to remain in the UKI have restricted right to work in the UK (Please provide details of restriction)

...........................................................................

...........................................................................

Other leave status permitting employment as a PHV driver (Please specify):

D3 Have you lived in a country other than the UK for one or more continuous periods of 3 months or more within the last 3 years? Not including extended holidays

Yes NoIf ‘Yes’, you are required to complete TPH/205 ‘Living and Working Abroad’ details form.The TPH/205 ‘Living and Working Abroad Details’ Form is available on the TfL website: (www.tfl.gov.uk/tph)A copy can also be requested by calling TfL on 0845 602 7000You must also submit a ‘Certificate of Good Conduct’ from the relevant country

If ‘No’, please indicate which exempted category you fall into:

Yes NoPlease complete details below

Authority Name Reason

PROCEED TO SECTION G

Please continue on a separate sheet if necessary.

4 of 6

G - Declaration

Transport for London (TfL) its subsidiaries and service providers will use your personal information (including any references to your health, ethnic origin, nationality, or previous criminal convictions), for the purpose of assessing your application, administering the licensing regime, and equal opportunities monitoring. Your personal information will be properly safeguarded and processed in accordance with the requirements of the Data Protection Act 1998.

Your name, badge/licence number and the status, start/expiry date of your licence may be made available on request or on a register for public inspection. If you have licensed a vehicle, the vehicle registration mark, licence number and expiry date may also be made available in the same way.

Information obtained by the police about taxi/private hire related criminal offences may be disclosed to TfL and used by TfL to refuse, suspend or revoke a taxi or private hire driver, operator or vehicle licence. TfL may inform the police of any decision to refuse, suspend or revoke a licence and information about drivers whose licence has been revoked following a conviction for touting may be published on the TfL website for a period of up to 11 months. In certain circumstances, TfL may also share your personal information with the police and other law enforcement agencies for the purposes of the prevention or detection of crime.

Your name and contact details may be disclosed to an external research company to conduct research amongst licensees on TfL’s behalf. This research will be related to TfL’s responsibilities for licensing, regulation, and integration between taxis/private hire services and other elements of the transport system. Your details will not be used for any marketing or other research activities.

More information about how TfL uses and protects personal information about taxi/private hire licensees is available at: www.tfl.gov.uk/privacy.

I declare that all information provided on this application form is true and correct to the best of my knowledge. I understand that providing false information is an offence punishable by a fine not exceeding the sum of £1000. I understand that the issue of a licence in respect of this application can be refused and any licence can be revoked if any statements are subsequently found to be false. I undertake to keep LTPH informed of any changes to any details supplied in this form, and I am aware that failure to do so will constitute a breach of my licence condition and may lead to the possible revocation and suspension of my licence.

I undertake to inform LTPH immediately if I am charged with, or convicted of, any criminal offence; receive a police caution; am disqualified from driving; made the subject of a mental health order or sexual offences order; or if my medical status changes in anyway that would affect my driving a PHV. I also give LTPH permission to access my criminal record with the police and the Criminal Records Bureau during the currency of my licence, as required.

I declare I am the named person and I authorise the Licensing Authority to ask DVLA for my driver record information as and when required, at a frequency the Licensing Authority shall determine, and for the Licensing Authority to hold that information in accordance with the principles of the Data Protection Act 1998. I authorise and direct DVLA to disclose, to the Licensing Authority from the computerised register of drivers maintained by DVLA relevant information relating to by driver record, including photo images (where appropriate), personal details, driving entitlements, endorsement details, disqualifications and convictions, except medical information. The authority will expire three years from the date of my signature.

Signature D D M M Y

PLEASE COMPLETE THE PAYMENT SECTION ON THE NEXT PAGE

Y Y YDate



H - Payment

For LTPH use onlyH1

H2

Payment by Credit / Debit* card(*Delete as applicable)

Card Type (e.g. Visa/Mastercard/Delta)

Please state:

Amount to be debited £ :

Card number:

Issue number: Valid from: Expiry date:M M Y Y

Cardholder’s name:

Authorised signature:

H3 Payment via Post Office®

Post Office® Stamp

Post Office® use only

PHD/

M M Y Y

Applicant’s name (if different from payer)

White BlackBritish Black Caribbean ChineseIrish Black AfricanAny other White background Please specify

...............................................

Any other Black background Please specify

...............................................

Any other background Please specify

...............................................

Asian or Asian British MixedIndian White and Black CaribbeanPakistani White and Black AfricanBangladeshi White and AsianAny other Asian background Please specify

...............................................

Any other Mixed background Please specify

...............................................

What gender are you?

Do you consider yourself to have a disability?

What faith/religion do you follow? Please state:

Yes No

Male Female

Equal Opportunities: Monitoring FormLondon Taxi and Private Hire (TPH) is committed to equal opportunities in its licensing policy, practices and procedures. To help us implement and monitor this policy, please could you provide us with the following information: (Please note: the information you provide is on a voluntary basis and will have no bearing on your application).

5 of 6

Transport for London (TfL), the Licensing Authority, needs to be satisfied that all licensed LondonTaxi and Private Hire drivers are medically fit. In assessing an individuals medical fitness, TfL has decided to be guided by the DVLA Group 2 standards.

This form should be taken to a registered medical practitioner who has access to your full medical history, typically your GP, for completion. If it is not completed by someone who has access to your full medical history, this could lead to delays in the processing of your medical.

This medical report is for the confidential use of TfL.

This medical report cannot be issued free of charge as part of the National Health Service. The applicant must pay the medical practitioners fee, unless other arrangements have been made. TfL accepts no liability to pay it.

If you possess a valid DVLA Group 2 licence or are already licensed by TfL as either a MHC (‘taxi’) or PHV driver and are now applying for the other licence, you do not need to have this form completed, unless this form has been requested in regards to confirming your age related fitness.

When completing this application please:

- Write inside the boxes - use BLOCK CAPITAL letters and black ink

- If you make a mistake, please cross it out (initial it) and write the correct information underneath

- Do not use correction fluid - Ensure that a response is provided for every question, unless specifically directed to the contrary.

On completion, this form should be returned to:

London Taxi and Private HirePalestra4th Floor Green Zone197 Blackfriars RoadLondon SE1 8NJ

Further information may be requested from you should it be required in order to determine your medical fitness.

TfL recommends that all individuals take a photocopy of this form once it is completed for their own record before submitting the original.

MAYOR OF LONDON1 of 8

TPH/204Medical Declaration For LTPH use only



2 of 8

Data ProtectionTransport for London (TfL) and its agents will use the information that you have provided on this form and subsequent information provided by you or others for the purpose of assessing your application to hold a Taxi or PHV Driver licence and for the administration of the licensing regime. If your application is successful, your name, licence number, licence status, issue date and expiry date will be made available on a public register. By signing this form you are consenting to the processing of your data by TfL for these purposes. Your information may be passed to law enforcement agencies if criminal activity is suspected or where we are otherwise required to do so by law.

Consent and DeclarationI hereby consent to Transport for London (TfL) and their medical advisers processing personal data relating to my medical condition for the purpose of assessing my fitness to hold a Taxi or PHV Driver licence. I also give consent for my doctors and specialists to provide TfL with any data they require in relation to this application.

TfL recommends that all individuals take a photocopy of this form once it is completed for their own record before submitting the original.

A - Personal Details

A1

A2

A3

Surname name

Forename(s)

Date of Birth

A4 Current addressPostcode House number

Rest of address

B - Registered GP Details

B1 Name of Registered GP

B2 AddressPostcode Premises number

Rest of address

C - Applicant/Driver Consent and Declaration

D D M M Y Y Y Y

D D M M Y Y Y YSignature Date

3 of 8

Sections D - F must be completed by the applicants/drivers registered GP (detailed in section B) who should :

- Have access to the applicants full medical history

- Answer all the relevant questions

- Consult the DVLA’s publication ‘At a Glance Guide to the Current Medical Standards of Fitness to Drive.’

http://www.dvla.gov.uk/at_a_glance/what_is.htm

Regulations state that Taxi and PHV drivers must satisfy TfL that they are medically fit to hold a driver’s licence. In assessing whether an applicant is medically fit, TfL will have regard to the medical standard that would apply in relation to a DVLA Group 2 licence.

If you answer ‘Yes’ to ANY of the questions on this medical form, you must consult the DVLA’s publication ‘At a Glance Guide to the Current Medical Standards of Fitness to Drive’ and provide ALL the relevant information required for the condition(s) in accordance with the requirements of a Group 2 licence entitlement.

Does the applicant have a history of:

(a) Acute Coronary Syndrome including Myocardial infarction

(b) Coronary artery by-pass graft (CABG)

(c) Percutaneous Coronary Intervention (P.C.I) (Angioplasty)

(d) Angina

(e) Heart failure

(f) ImplantableCardioverterDefibrillator(ICD)

(g) Any other coronary artery procedure

If you answer ‘Yes’ to any of the above, please provide further details in section E (on page 8) and submit any relevant reports.

D - Medical Conditions - to be completed by GP

1 Cardiovascular disease/procedure

Yes No

2 Other cardio-vascular disorders/procedures


(a) Cardiac arrhythmia

(b) Peripheral arterial disease


Yes No

If ‘Yes’, please provide date(s):

If ‘Yes’, please provide date(s):

If ‘Yes’, please give date of most recent intervention:

If ‘Yes’, please give date of the last known attack:

If ‘Yes’, please provide the date of the last recorded occurrence: AND complete question 3 (3)

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

4 of 8

2 Other cardio-vascular disorders/procedures


(a) Aortic aneurysm If ‘Yes’, please provide the following:

(i) Site of aneurysm

(ii) Has it been successfully repaired?

(iii) Please provide size of aortic diameter ................................... and date obtained:

Thoracic Abdominal

(b) Dissection of the aorta If ‘Yes’, please provide copies of all reports to include those dealing

with any surgical treatment

(c) Hypertension

(d) Systolic reading consistently above 180/diastolic reading consistently above 100

(e) Please provide a current blood pressure reading ......................................................

(f) Cardiomyopathy If ‘Yes’, please state which type: ...............................................................................

AND provide full details in section E (on page 8)

(g) Congenital heart disorders

(h) Any other cardiac condition(s) not listed above


(a) Has the applicant undergone an exercise ECG test

(b) Has the applicant undergone a myocardial perfusion scan or stress echo study

(c) Has the applicant had an LVEF reading taken?

3 Cardiac investigations

D D M M Y Y Y Y

Please provide the reading (e.g. 40% or 0.4):

Please provide the date reading was taken AND provide full details in section E (on page 8)

4 Musculoskeletal

(a) Does the applicant have any deformity or physical disability (with special attention paid to the conditions of the arms, legs, hands and joints)

(b) Isthislikelytointerferewithefficientdischargeofhisorherdutiesasavocationaldriver


Yes No

Yes No

If ‘Yes’, please give date and provide full details in section E (on page 8)

If ‘Yes’, please give date and provide full details in section E (on page 8)

Yes No

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

5 of 8

5 Diabetes Mellitus

(a) Does the applicant have diabetes mellitus? If ‘No’, please continue to question 6 If ‘Yes’, is it managed by:

(i) Diet alone

(ii) Oral hypoglycaemic agents

(iii) Insulin

(iv) Exenatide/Gliptins

(i) During the past 12 months prior to the date of the licence application, has the applicant suffered a hypoglycaemic episode requiring the assistance of another at any time (If ‘Yes’ please provide further details below)

(ii) Does the applicant have a history of responsible diabetic control (If ‘No’ please provide further details below)

(iii) Does the applicant have good hypoglycaemic awareness (If ‘No’ please provide further details below)

(iv) As far as you know, is the applicant adherent to treatment protocols and twice daily blood sugar measurements (If ‘No’ please provide further details below)

(v) Is the applicant at minimal risk (i.e. Low risk) of hypoglycaemic attack resulting in incapacity (If ‘No’ please provide further details below)

(vi) Does the applicant have any complications of diabetes which may interfere with driving (If ‘Yes’ please provide further details below)

Yes No

If ‘Yes’, please give date started on insulin and complete ALL of question (b) below

If ‘Yes’, please give date started on exenatide/gliptins and complete ALL of question (b) below

Yes No(b) Diabetic history

Yes No

YesNo

YesNo

YesNo

YesNo

D D M M Y Y Y Y

D D M M Y Y Y Y

Diabetes Mellitus further information

6 of 8

6 Neurological


(a) Seizure/Epileptic attack and/or having taken anti-convulsant/epileptic medication in the last 10 years

(b)Afirstunprovokedepilepticseizure/solitaryfitwithinthelast5years

(c) Blackout/Impairment of Consciousness

(d) Stroke/TIA

(i) Has there been a full recovery?

(ii) Is there any debarring residual impairment that would affect safe driving?

(iii) Any other significant risk factors?

(iv) Is there any imaging evidence of essentially normal carotid arteries?

(v) Has exercise/functional testing been undertaken? If ‘Yes’, please ensure you complete question 3 of this form (on page 4)

(e) Sudden Disabling Dizziness/Vertigo

(f) Pathological Sleep Disorder

(g) Chronic and/or Progressive Neurological Disorder

(h) Brain Surgery

(i) Serious Head Injury

(j) Brain Tumour


7 Psychiatric


(a) Psychiatric Disorder

(b) Psychotic Illness

(c) Dementia /Cognitive Impairment

(d) Alcohol Misuse

(e) Alcohol Dependency

(f) Drug or Substance Misuse

(g) Drug or Substance Dependency


Yes No

If ‘Yes’, please give the date and complete ALL the questions below:

Yes No

D D M M Y Y Y Y

7 of 8

8 Vision

Applicants visual acuity must be at least 6/9 in the better eye and at least 6/12 in the other (6/9 and 6/12 being the ability to read the full 9 and 12 line of the Snellen chart at 6 metres)

Applicants who use corrective lenses must also be able to achieve an uncorrected visual acuity reading to be at least 3/60 in both eyes (3/60 being the ability to read the 60 line of the Snellen chart from 3 metres)

If you do not have the equipment to carry out the required tests, please refer the applicant to an ophthalmic specialist or optician

(a) Pleaseconfirmtheapplicantsvisualacuityintheformatabove:

Right

Left

UNCORRECTED CORRECTED

(b) Does the applicant use corrective lenses?

(c) Doestheapplicanthaveanormalbinocularfieldofvision?

(d) Does the applicant have uncontrolled diplopia?

(e) Does the applicant have any other ophthalmic condition?

9 Any other conditions

(a) Does the applicant named in Section A suffer from any recognised medical condition (such as severe asthma, allergic reaction or chronic phobia) that would preclude them from carrying Guide and/or Assistance dogs?

If YES, please request form TPH/208, which must be completed by a Specialist in the field that you require exemption

(b) (i) Does the applicant suffer from any other disease or disability that has not been previously mentioned?

(ii) Isthislikelytointerferewiththeefficientdischargeofhisorherdutiesasavocational driver, or to cause driving by him or her to be a source of danger to the public?

If you answer ‘Yes’ to any of the above, please provide further details in section E (on page 8) and submit any relevant reports

Yes

No

Yes

Yes

No

Yes

No

No

Yes No

Yes No

If YES, please provide further details in Section E (on page 8)

Please use the space below to provide further, legible details required with reference to any of the previously answered questions. Please include relevant dates. It will be necessary to consult the DVLA’s publication ‘At a Glance Guide to the Currrent Medical Standards of Fitness to Drive’ and provide information as per Group 2 standards of fitness. http://www.dvla.gov.uk/at_a_glance/what_is.htm

I certify that, at the time of examination and completion of this medical form, I had possession of the applicants complete medical history.

E - Further Details

F - Declaration - to be completed by GP

TPH/204 V1, 11/2011

8 of 8

Surgery Stamp

D D M M Y Y Y YDate

Signature

Name (BLOCK CAPITALS)

An Enhanced CRB Disclosure is required as part of your licence application. TMG CRB has been appointed to

administer CRB applications on behalf of London Taxi and Private Hire (LTPH).

You will need to make your CRB application before you submit your licence application to LTPH. The CRB

application can be made either online or via a paper-based form.

Online CRB application

To apply online you need access to a computer and an email address.

The online application is recommended as it is cheaper, easier and quicker. You are guided through each step of the

process via our online tools to ensure that your application is complete and accurate.

Online application is a four step process:

1. Complete personal details online

2. Select ID for verification using the online help tool

3. Have original documents verified at the Post Office

4. Pay for the CRB application at the Post Office

To commence your online CRB application, go to www.online.tmgcrb.co.uk and select REGISTER from the

login screen.

Select and complete the appropriate details using the below table.

Follow the onscreen instructions to complete your application. Full guidance notes can be downloaded from

www.tmgcrb.co.uk/tph

CRB application process for PH drivers applying for new licence applications

1 of 2

PH Drivers

GeneralContract to specifically drive vulnerable adults

Org PIN 104177 104178

Org name PH Driver (New Children) PH Driver (New Children & Vul Adults)

Secret word tphcrb tphcrb

2 of 2

Licence application

As part of your licence application you will be asked to provide a reference number. If you are completing an online

application, you will be required to provide an ‘E Number’. This will be emailed to you if you have chosen to receive

email progress updates as part of your application. Otherwise it can be obtained by logging into your online

application three days after submitting it.

Paper CRB application

If you do not have access to a computer or email address, a paper-based application is available.

To request a paper application pack, please contact TMG CRB on 0845 251 5000 or email [email protected]

Fees

Online (includes ID verification): £55

Paper (excludes ID verification): £57

For the paper application service TMG CRB recommend using the Post Office ID checking service form (additional

£7.15 payment to be made at the Post Office Counter). Alternatively you can mail original documents to TMG CRB

via Special Delivery including a pre-paid Special Delivery envelope for safe document return.

Help and support

Should you require help and support with your CRB application you can contact our dedicated TPH CRB

administration team on 0845 251 5000 or [email protected]

Our TPH CRB Administration team helpline is available between 8.30am – 5.30pm Monday to Friday with a 24-hour

messaging service.

TPH @ TMG CRB, 1 Wilford Business Park, Ruddington Lane, Nottingham, NG11 7EP

E: [email protected] T: 0845 251 5000 W: www.tmgcrb.co.uk

2922/CRB-116/06/1111

Please read if you have either chosen to download an application pack from the TfL website or been sent an e-mail version of the pack directly.

As you have received an application pack by this method, there are some subtle differences from the postal pack. Please can you therefore remember to:

1. Staple your documents together

Please staple all of your documents together in the relevant bundle of forms. For example: staple all the 203 application form pages together and all the TPH/204 Medical Declaration forms together.

2. Place all your application documents in an appropriately sized (A4) envelope

Unfortunately, despite the covering letter to the application form stating that an envelope is included, as you have downloaded this form, we are not able to do so.

3. Add some details about your application to the front of the envelope

To assist in the efficient processing of your application, please update the front of the envelope with your name and the type of licence being applied for. See the enclosed diagram of how to update the envelope correctly.

Please note: for Renewals only – You will need to state your licence number and expiry date on the envelope.

4. Post your application to the correct address

You should send all your fully completed application documents to the following address:

London Taxi and Private Hire Palestra 4th Floor Green Zone 197 Blackfriars Road London SE1 8NJ

Alternatively, you could use the Check and Send service provided by the Post Office ® on behalf of London Taxi and Private Hire (LTPH). LTPH recommends the use of the Post Office Check and Send service as it has proven to reduce the number of unnecessary errors and omissions made in the applications process. This leads to delays and understandable frustrations for applicants.

Please refer to the application pack for further details of how to use this service.

5. Ensure you pay the correct amount of postage

London Taxi and Private Hire Palestra

4th Floor Green Zone 197 Blackfriars Road

London SE1 8NJ

AFFIX YOUR POSTAGE

HERE

WRITE YOUR NAME HERE

PHV NEW WRITE THE TYPE OF APPLICATION YOU ARE APPLYING FOR HERE

For example: PHV NEW PHV RENEWAL TAXI NEW TAXI RENEWAL

John Smith

Licence No: 12345

Expiry: 01/01/12 FOR RENEWALS ONLY: WRITE YOUR LICENCE NUMBER AND EXPIRY DATE HERE

Documents

Private Hire Driver Application Pack