Plate Exemption Application Form

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1. PLEASE INDICATE APPLICATION STATUS ( as appropriate)	
New          	
                                                                                                   Renewal   	

2. VEHICLE DETAILS	

VEHICLE LICENCE NUMBER:                                                        EXPIRY DATE:

VEHICLE REGISTRATION NUMBER:

DATE VEHICLE FIRST REGISTERED:

MAKE:                                                                                                         MODEL:

COLOUR:                                                                 NUMBER OF PASSENGERS:

3. PROPRIETOR PERSONAL DETAILS (1)	
TITLE ( as appropriate): Mr  Mrs   Miss   Ms   Other (please state): 	

FORENAMES: 

SURNAME:     	

CURRENT ADDRESS: 

	

4. PROPRIETOR PERSONAL DETAILS (2)	
TITLE ( as appropriate): Mr  Mrs   Miss   Ms   Other (please state): 	

FORENAMES: 

SURNAME:     	

CURRENT ADDRESS: 

	

5. LIST OF ALL DRIVERS OF THE VEHICLE (& LICENCE NUMBERS)	

	

6. DETAIL OF REASONS/ CIRCUMSTANCES WHY THE REQUEST FOR PLATE EXEMPTION IS BEING MADE	

Declarations	

I understand that the grant of any plate exemption will be in line with the following conditions:

1.	Vehicles granted a plate exemption waiver shall be used only for Prestige type hirings and shall not be used for standard private hirings.
2.	The Operator receiving a booking for a plate exempted vehicle shall provide the hirer with details of the vehicle registration number and the name of the driver, prior to the hiring commencing.
3.	 The private hire identification disc issued by the Council shall be displayed within the front nearside of the windscreen at all times and legible from outside the vehicle. 
4.	The rear vehicle licence plate shall be securely fixed within the boot of the vehicle in a manner which enables it to be easily inspected.
5.	The driver’s badge shall be available for inspection by an authorised officer of the Council, a police officer or by the hirer of the vehicle, on request.
6.	The Council’s agreement to a plate exemption is required to be carried on the vehicle at all times and to be available for inspection by an authorised officer of the Council, a police officer or by the hirer of the vehicle, on request.
7.	The driver of a plate exempted vehicle shall wear professional business attire.
8.	The hirer shall not have the facility to settle accounts and / or tender direct payment to the driver by any means. Payment may only be made, either before or after the journey, direct to the Operator or their accounting system.  
9.	No alcoholic drink shall be sold or purchased in or from the vehicle.
I understand that Newly licensed vehicles which are accepted as Executive/ Prestige type vehicles for the purposes of vehicle plate exemption will not be entitled to have a transponder.  Existing vehicles transferring to plate exemption will be required to surrender their transponder.  In this event, if the transponder returned is the one which matches with our records and is in full working order then we can make arrangements for the deposit to be refunded to the proprietor (this can take up to 14 working days).
The personal information that you give us will also be used in a confidential manner to help us monitor our processes.  

We may also use the information if there is a complaint or legal challenge relevant to this process.  We may check the information collected.  

We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law.  

By signing the application form we will be assuming that you agree to the processing of sensitive personal data, in accordance with our registration with the Data Protection Commissioner.

Signed: __________________________________________________________Dated:     /    /      
(Proprietor 1)

Signed: __________________________________________________________Dated:     /    /      
(Proprietor 2)	

FOR OFFICE USE ONLY

DATE EXEMPTION APPLICATION RECEIVED: 
	
Section B	

EXEMPTION AGREED 

EXEMPTION DECLINED

Section C	

If exemption declined, give reasons:

Signed: __________________________________________________________Dated:     /    /      
	
Section D	

Date Plate Exemption Windscreen Sticker Issued: