Transport for London

London Taxi and Private Hire

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: 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 Check As 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 TfLs 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 Assessment Unless 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.aspx The topographical assessment requires the following range of skills to be demonstrated: Map reading ability how to use a map, index and grid reference Route 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.

MAYOR OF LONDON
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PHV/203 V4, 11,2011

Medical Fitness TfL needs to be satisfied that all licensed London Taxi and Private Hire drivers are medically fit. In assessing an individuals 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 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 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 TfLs licensing guidelines. This can be found at www.tfl.gov.uk/tphby 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/finder For 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) - 157 3. 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).
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Transport for London

London Taxi and Private Hire

PHV/203
London Private Hire Driver Licensing Application Form
Mandatory Requirements
(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 Yes Yes No No Please attach a recent colour, passport-sized photograph of yourself here
For LTPH use only

PHD/

A - Personal Details

Yes

No

(d) Do you have the right to work in Yes No the UK? You must answer Yes to all of the above questions to meet the minimum requirements for licensing.

Application Checklist
To submit a complete application, please ensure you have provided: 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 licence Please 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 A signed declaration in Section G Full payment to cover the cost of your application and grant of licence fee - Section H

A1 Surname

A2 Forename(s)

A3 Date of Birth D D M M Y Y Y Y A4 Gender Male A5 Title Mr Mrs Miss Ms Other (Please specify) ............................... A6 Daytime telephone number Female

A7 Mobile telephone number

Where applicable:
TPH/205 & Certificate of Good Conduct - see Section D A copy of Topographical Skills Certificate

A8 E-mail address

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/tph PLEASE COMPLETE FORM USING BLACK INK.

MAYOR OF LONDON
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A - Personal Details continued...

A9 Current address Postcode Rest of address House number

C - CRB Reference 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 TfLs Service Provider TMG CRB Unless a scenario in C2 applies, you cannot submit your licensing application until you have made an application for a CRB disclosure with TMG CRB For 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: E If you completed a paper CRB application, please state your F number: F If you have already been issued with a CRB disclosure please state the disclosure number: No

A10 Is the above address on your driving licence?

Yes

No

(If No, your application cannot proceed) A11 Have you been previously known by any other names?

Yes Please complete questions A12 - A15

A12 Previous surname name

A13 Previous forename(s)

A14 Previous title

Mr

Mrs

Miss

Ms

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

Other (Please specify) .........................................

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

D D M M Y Y Y Y

B - Driving Licence Details

B1 What is your DVLA driving licence number?

B2 What is your EEA state driving licence number (if applicable)

B3 What is the date your full driving licence was first issued? D D M M Y Y Y Y
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.
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D - Leave Status - Right to take Employment

D1 What is your country of birth?

E - Topographical Skills
E1 Have you provided a topographical skills assessment certificate with this application? Yes No

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 status I am awaiting a decision on an application to be granted asylum/refugee status I have been granted indefinite leave to remain in the UK I am awaiting a decision on an application for leave in the UK I have limited leave to remain in the UK I have restricted right to work in the UK (Please provide details of restriction) ........................................................................... ........................................................................... Other leave status permitting employment as a PHV driver (Please specify):

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

I 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 driver I hold a recognised relevant vocational driving qualification (NVQ or equivalent) Please enclose a copy of your certificate I am a professional tourist guide affiliated to:

(organisation name)

Please enclose a copy of your certificate

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 Please complete question F2 F2 What is your licence type and number? Taxi badge number: Knowledge reference number: PHV driver licence number: No

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 employment In 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. 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 No
If 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 7000 You must also submit a Certificate of Good Conduct from the relevant country
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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 Please complete details below Authority Name Reason No

Please continue on a separate sheet if necessary.

PROCEED TO SECTION G

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 TfLs behalf. This research will be related to TfLs 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 Date D D M M Y Y Y Y

PLEASE COMPLETE THE PAYMENT SECTION ON THE NEXT PAGE

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Transport for London

London Taxi and Private Hire

Equal Opportunities: Monitoring Form
London 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). White British Irish Any other White background Please specify ............................................... Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background Please specify ............................................... What gender are you? Do you consider yourself to have a disability? What faith/religion do you follow? Please state: Black Black Caribbean Black African Any other Black background Please specify ............................................... Mixed White and Black Caribbean White and Black African White and Asian Any other Mixed background Please specify ............................................... Male Yes Female No

Chinese Any other background Please specify ...............................................

H - Payment
H1 Payment by Credit / Debit* card
(*Delete as applicable)
For LTPH use only

H2 Card Type (e.g. Visa/Mastercard/Delta) Please state: Amount to be debited Card number: Issue number: Cardholders name: Authorised signature: Valid from: M M Y Y Expiry date: M M Y Y
:

PHD/ H3 Payment via Post Office

Post Office use only

Post Office Stamp

Applicants name (if different from payer)

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Transport for London

London Taxi and Private Hire

TPH/204
Medical Declaration
For LTPH use only

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 Hire Palestra 4th Floor Green Zone 197 Blackfriars Road London 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 LONDON
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A - Personal Details
A1 Surname name

B - Registered GP Details
B1 Name of Registered GP

A2 Forename(s)

B2 Address Postcode Rest of address Premises number

A3 Date of Birth D D M M Y Y Y Y A4 Current address Postcode Rest of address House number

C - Applicant/Driver Consent and Declaration

Data Protection
Transport 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 Declaration

I 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. Signature Date D D M M Y Y Y Y

TfL recommends that all individuals take a photocopy of this form once it is completed for their own record before submitting the original.
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D - Medical Conditions - to be completed by GP

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 DVLAs 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 drivers 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 DVLAs 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. 1 Cardiovascular disease/procedure Yes No

Does the applicant have a history of:

(a) Acute Coronary Syndrome including Myocardial infarction If Yes, please provide date(s): (b) Coronary artery by-pass graft (CABG) If Yes, please provide date(s): (c) Percutaneous Coronary Intervention (P.C.I) (Angioplasty) If Yes, please give date of most recent intervention: (d) Angina If Yes, please give date of the last known attack: (e) Heart failure (f) Implantable Cardioverter Defibrillator (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. 2 Other cardio-vascular disorders/procedures 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 D D M M Y Y Y Y

Does the applicant have a history of: (a) Cardiac arrhythmia If Yes, please provide the date of the last recorded occurrence: AND complete question 3 (3) (b) Peripheral arterial disease

D D M M Y Y Y Y

If you answer Yes to any of the above, please provide further details in section E (on page 8) and submit any relevant reports.
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Other cardio-vascular disorders/procedures Yes No

Does the applicant have a history of: (a) Aortic aneurysm If Yes, please provide the following: (i) Site of aneurysm Thoracic Abdominal

(ii) Has it been successfully repaired? (iii) Please provide size of aortic diameter and date obtained: (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 If you answer Yes to any of the above, please provide further details in section E (on page 8) and submit any relevant reports. 3 Cardiac investigations (a) Has the applicant undergone an exercise ECG test If Yes, please give date and provide full details in section E (on page 8) (b) Has the applicant undergone a myocardial perfusion scan or stress echo study If Yes, please give date and provide full details in section E (on page 8) (c) Has the applicant had an LVEF reading taken? 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) Is this likely to interfere with efficient discharge of his or her duties as a vocational driver If you answer Yes to any of the above, please provide further details in section E (on page 8) and submit any relevant reports.
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D D M M Y Y Y Y

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

Yes

No

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

Yes

No

(ii) Oral hypoglycaemic agents (iii) Insulin If Yes, please give date started on insulin and complete ALL of question (b) below (iv) Exenatide/Gliptins If Yes, please give date started on exenatide/gliptins and complete ALL of question (b) below (b) Diabetic history (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) D D M M Y Y Y Y D D M M Y Y Y Y

Yes

No

No No No

Yes Yes Yes

(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) Diabetes Mellitus further information

No Yes

Yes No

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Neurological
Yes No

Does the applicant have a history of: (a) Seizure/Epileptic attack and/or having taken anti-convulsant/epileptic medication in the last 10 years (b) A first unprovoked epileptic seizure/solitary fit within the last 5 years (c) Blackout/Impairment of Consciousness (d) Stroke/TIA If Yes, please give the date and complete ALL the questions below: (i) Has there been a full recovery?

D D M M Y Y Y Y

(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 If you answer Yes to any of the above, please provide further details in section E (on page 8) and submit any relevant reports. 7 Psychiatric
Yes No

Does the applicant have a history of: (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

If you answer Yes to any of the above, please provide further details in section E (on page 8) and submit any relevant reports.
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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) Please confirm the applicants visual acuity in the format above: UNCORRECTED Right CORRECTED

Left

Yes (b) Does the applicant use corrective lenses? No (c) Does the applicant have a normal binocular field of vision? Yes (d) Does the applicant have uncontrolled diplopia? Yes (e) Does the applicant have any other ophthalmic condition? If YES, please provide further details in Section E (on page 8)

No

Yes

No

No

Any other conditions Yes (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? No

If YES, please request form TPH/208, which must be completed by a Specialist in the field that you require exemption
Yes No

(b) (i)

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

(ii) Is this likely to interfere with the efficient discharge of his or her duties as a vocational 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
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E - Further Details
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 DVLAs 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

F - Declaration - to be completed by GP
I certify that, at the time of examination and completion of this medical form, I had possession of the applicants complete medical history. Signature Surgery Stamp

Date

D D M M Y Y Y Y

Name (BLOCK CAPITALS)

TPH/204 V1, 11/2011

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CRB application process for PH drivers applying for new licence applications
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. 2. 3. 4. Complete personal details online Select ID for verication using the online help tool Have original documents veried at the Post Office 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.

PH Drivers General Org PIN Org name Secret word 104177 PH Driver (New Children) tphcrb Contract to specically drive vulnerable adults 104178 PH Driver (New Children & Vul Adults) tphcrb

Follow the onscreen instructions to complete your application. Full guidance notes can be downloaded from www.tmgcrb.co.uk/tph

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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 tphcrb@tmgcrb.co.uk

Fees
Online (includes ID verication): 55 Paper (excludes ID verication): 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 tphcrb@tmgcrb.co.uk 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: tphcrb@tmgcrb.co.uk T: 0845 251 5000
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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

PHV NEW

WRITE THE TYPE OF APPLICATION YOU ARE APPLYING FOR HERE

For example: PHV NEW PHV RENEWAL TAXI NEW TAXI RENEWAL

AFFIX YOUR POSTAGE HERE

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

John Smith Licence No: 12345 Expiry: 01/01/12

WRITE YOUR NAME HERE

FOR RENEWALS ONLY: WRITE YOUR LICENCE NUMBER AND EXPIRY DATE HERE