Hackney Carriage and Private Hire Licensing Policy

19. Appendix 10: information disclosure form

This form is submitted following a search of the National Register of Refusals and Revocations (NR3). (For completion by requestor authority)

Name of licensing authority requesting information: ………

Requestor authority reference number: ……..

Name of licensing authority from which information is sought: ………

Name of individual in respect of whom the request is made: ……….

Decision in respect of which the request is made: Refusal / revocation

Other details for this record: …….

Address: …….

Driving licence #: ……

NI #: …….

Reference number: ……

Declaration by requesting authority:

The authority hereby confirms that this information is being sought in connection with the exercising of its statutory function to ensure that holders of taxi / PHV licences are fit and proper persons, and that 99 the processing of this data is therefore necessary in the performance of a task carried out in the public interest.

The information provided below will only be processed, used and saved by the authority in connection with this particular application and in accordance with all relevant data and privacy requirements, as previously advised by the authority to applicants for and existing holders of taxi and PHV licences, and will be retained in accordance with the Authority’s retention policy relating to the provision of such information.

To enable the authority to conduct a data protection impact assessment, details of this authority’s policy in relation to the use of information obtained as a result of this request can be accessed at https://www.buckinghamshire.gov.uk/parking-roads-and-transport/taxis-and-private-hire/taxi-licence-applications/


Name: ……

Position: ……


(For completion by providing authority)

Further information to support the decision recorded on NR3 in respect of the above named individual:

Declaration by providing authority:

The authority hereby confirms that it has conducted a data protection impact assessment. It also confirms that the information above is accurate, and has been provided after thorough consideration by the authority as to the proportionality and lawfulness of making this disclosure. The information reflects the basis on which the decision recorded in the National Register of Refusals and Revocations was made. In the event that the authority becomes aware that this information is no longer accurate, we will advise the above named authority accordingly.

The authority also confirms that, as part of the basis for securing, retaining or applying for a taxi / PHV licence, the above named individual has been made aware of to the fact that this information will be shared, in accordance with all relevant data and privacy requirements


Name: ……

Position: ……

Date: …….