Apply TPH/205 Form – Fill Out and Use This PDF

If you have stated on your application form that you have lived in a country other than the UK for one or more continuous periods of 3 months or more within the last 3 years, please provide the following information in the section(s) on the reverse of this form:

•The date that the period of living and working abroad began and ended

•The full address (in as full a format as possible) where you were living

•The name of your employer (if applicable)

•The employers telephone number (if available)

•Details of any convictions gained as a result of offences committed during this period

•Do not include periods of extended holiday/vacation.

PLEASE NOTE: Those applicants who complete form TPH/205, conirming that they have lived in a country other than the UK for one or more periods of three months or more, within the last three years, will be required to produce a Certiicate of Good Conduct issued by the relevant non-UK country. A ‘Certiicate of Good Conduct’ is an extract from the judicial record or an equivalent document issued by a competent judicial or administrative authority

in the relevant country.

In order to obtain a Certiicate of Good Conduct and for up to date information on any costs involved, you should contact the Embassy or High Commission of the country in question.

A translation will be required if it is not provided in English.

Failure to provide a certiicate may prevent an application being considered. Failure to provide such information, without good reason, will be taken into account when a decision is made. Transport for London (TfL) will consider each individual case on its own merits, having regard to the need to protect the safety of the travelling public and whether the applicant has demonstrated that they are a ‘it and proper’ person to hold a licence.

When completing this form

4Please use BLOCK CAPITALS and black ink

8 Please do not use correction luid

A - Personal Details

A1 Licence or reference number (if applicable)

A2 Surname/family name

A3 Forename(s)

A4

Date of Birth

D

D

M

M

Y

Y

Y

Y

MAYOR OF LONDON

1 of 2

B - Living and Working Abroad Details

If you have lived and worked abroad for more than one period, please photocopy this page, complete a copy for each period and attach to the form.

B1 Period from D D M M Y Y Y Y to D D M M Y Y Y Y

B2 Address

B3 Name of employer (if applicable)

B4 Telephone number (if available)

If you have completed the sections above, please complete the table below to conirm any criminal convictions gained as a result of offences committed during this period.

B5 Were you convicted of any criminal offences committed during this period of living abroad? (4)

	No		Yes	(Please provide further details below)
Date of Offence				Nature of Offence	Date of Conviction	Sentence

C - Data Protection

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. Further information, including a full copy of the Taxi and Private Hire Privacy notice, is available at tl.gov.uk/privacy

D - Declaration

I declare that all information provided on this form is true and correct to the best of my knowledge. I understand that the issue of a licence in respect of this information 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 conditions and may lead to the possible revocation and suspension of my licence.

Signature

Date

D

D

M

M

Y

Y

Y

Y

TPH/205

V1, 11/2011

2 of 2