Liverpool City Council

Details of vehicle proprietor

This form is designed to capture information required under Section 50(3) of the Local Government (miscellaneous Provisions) Act 1976 which states that if the safety, comfort or appearance of a licensed vehicle is damaged, the accident must be reported within 72 hours. The vehicle proprietor must complete this form.

First name

Last name

Address

Postcode

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Email address

Telephone number

Details of vehicle

Is the licensed vehicle a

Hackney Carriage
Private hire

Registration

Licence plate number

Licence expiry date

Mileage of licensed vehicle

Name of driver at time of accident

Driver's badge number

Is your vehicle off the road?

Yes
No

Address of the vehicle's location

Postcode

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Telephone number - optional

Is the vehicle still being driven?

Yes
No

Details of declaration

Warning: Failing to provide the required information or providing false or incorrect information may result in prosecution.

Confirmation

I confirm that I am the vehicle proprietor of the damaged vehicle and declare that the information given in this form is true. I also understand that it is a criminal offence to make a false statement or omit any material particular from this form.

Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page

Report an accident involving your Hackney Carriage or Private Hire Vehicle