Report an accident involving your Hackney Carriage or Private Hire Vehicle

Progress

Name of vehicle proprietor

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.

Address
 

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Vehicle details

Details of vehicle
Is the licensed vehicle a
Is your vehicle off the road?
Address of the vehicle's location
 

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Is the vehicle still being driven?

Details of the accident

Accident details

hh:mm, 24 hour format

Is the damage to the licensed vehicle
Front

(e.g. scratch, dent or missing part)

Rear

(e.g. scratch, dent or missing part)

Near side front

(e.g. scratch, dent or missing part)

Near side rear

(e.g. scratch, dent or missing part)

Off-side front

(e.g. scratch, dent or missing part)

Off-side rear

(e.g. scratch, dent or missing part)

Were you injured?
Were you carrying passengers at the time of the incident?
Were your passengers injured? (optional)

Contact name and address of passengers

To add contact details of other passengers, click 'Add passenger details'

Add passenger details

Other vehicles involved

Third party vehicle and details

Details of third-party vehicle
Do you have the details of the third party involved in this accident?

Please complete the following questions

Describe damage to third-party vehicle (optional)
Address of owner/proprietor (optional)
 

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Was the driver injured?
Were the passengers injured?

Contact name and address of passengers

To add contact details of other passengers, click 'Add passenger details'
Address (optional)
 

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Add passenger details

Was the accident reported to the police?

Declaration

Details of declaration

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

Confirmation

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