S.I. No. 211/1988 - Road Transport (Merchandise Licence Application Form) Regulations, 1988.

To:

The Secretary,

Department of Tourism and Transport.

Important:

A decision on this application will be delayed if all sections of this form are not completed and all of the evidence requested is not furnished, at the time of application.

I/We wish to apply for a .......................................... (insert National or International as appropriate) Road Freight Carrier's Licence and declare that the information furnished in this application is true.

I/We enclose the sum of £ ............... in respect of the licence fee together with the sum of £ ........... covering ............... vehicles at a fee of £ ............. per vehicle.

1. Full Name of Applicant:

(This is the name in which the licence. if granted, will issue and is therefore the only name under which propsed business can be lawfully operated).

2. Business or Trade Name (if any):

3. Description of Applicant:

Please tick as appropriate.

( ) LIMITED COMPANY

If so, the Memorandum and Articles of Association and Certificate of Incorporation must accompany this application.

( ) PARTNERSHIP

( ) SOLE PROPRIETOR

( ) OTHER—(Please describe)

4. Business Address of applicant:

5. If the Applicant is a Limited Company the address of Registered Office if different from Business address of Applicant:________________________________________________________________

6. Business Telephone Number:

7. Does the Applicant hold a licence for the carriage of merchandise for reward in the United Kingdom of Great Britain and Northern Ireland or any other EC Member State?

YES ( )

NO ( )

If yes. please state the type of licence and the Member State(s) in question: ____________________

8. What involvement or interest (whether financial or otherwise) has the Applicant in any merchandise road transport business in the United Kingdom of Great Britain and Northern Ireland or any other EC Member State? If none, this should be so stated: __________________________________________

9. How many persons (including working proprietors and unpaid family members) are or will be working in the merchandise road transport business of the Applicant?:_________________________

Signature of Applicant

Position in Business

(i) In the case of an Individual, the application must be signed by the person in whose name the application is made.

(ii) In the case of a Partnership, the application must be signed by each of the Partners.

(iii) In the case of a Limited Company or other Body Corporate, the application must be signed by a Director, Company Secretary or other authorised officer of the company and the person signing the form should indicate his/her status, e.g. Director, Company Secretary etc.

VEHICLES TO BE OPERATED IN PROPOSED BUSINESS

10. Please insert below the required particulars in respect of each vehicle which the Applicant wishes to have authorised under the licence. Every vehicle listed below shall be currently taxed and insured for at least one month following the date of this application and for which tachograph calibration certificates are enclosed. (If calibration certificate is not available other evidence of calibration, e.g. invoice or letter from garage proprietor may be submitted instead).

11. Please give the address of the Vehicle Palte Issuing Station at which Applicant desires that vehicles plates should be available for issue:

12. Does the Applicant propose to carry:

(a) Materials classified as dangerous substances?

YES ( )

NO ( )

(b) Radioactive materials?

YES ( )

NO ( )

If yes, to either (a) or (b) above, please give details.?

13. In relation to the carriage of dangerous substances:

(i) Is the Applicant aware of the regulations governing the conveyance of dangerous substances published by the Department of Labour?

YES ( )

NO ( )

(ii) Have drivers employed by the Applicant to carry dangerous substances received training under the regulations referred to at (i) above?

YES ( )

NO ( )

(iii) Have the tanks of all tank vehicles engaged in the carriage of dangerous substances undergone inspection and certification as required under the regulations referred to at (i) above?

YES ( )

NO ( )

14. In relation to the carriage of radioactive materials:

(i) Is the Applicant aware of the International Atomic Energy Agency's (IAEA) transport regulations?

YES ( )

NO ( )

(ii) Have drivers and other employed in the carriage of radioactive materials been furnished with a copy of the Nuclear Energy Board's "Notes for Drivers and others involved in Road Transport of Radioactive Materials"?

YES ( )

NO ( )

Please Note—"The carriage of radioactive materials can only be undertaken for persons or undertakings who hold a licence from the Nuclear Energy Board."

GOOD REPUTE

15. If the Applicant is a Company or Partnership, please give the name and home address of each of the Directors or Partners:

Name

Home Address

16. Please give details of any conditions for relevant offences as set out in the First Schedule to the European Communities (Merchandise Road Transport) Regulations, 1988 ( S.I. No. 180 of 1988 ), during the period of five years ending on the date this application is lodged with the Department in respect of the following:

(i) the Applicant, where the Applicant is an individual,

(ii) any of the partners, where the Applicant is a partnership,

(iii) the company of any director thereof, where the Applicant is a company,

(iv) the Transport manager.

If there were no convictions please write NONE.

FINANCIAL STANDING

17. The following evidence that the Applicant satisfies the requirement of appropriate financial standing must accompany this application:

(i) evidence of ownership (receipt of purchase or lease or hire agreement) or proof of availability of a goods vehicle over 2.5 metric tons unladen weight which is to be authorised under the licence,

and

(ii) registration book and Certificate of Insurance for each vehicle to be used in the business. (Each vehicle must be taxed and insured for at least one month following the date the application is lodged with the Department),

and

(iii) written confirmation from bank or other financial institution of the availability of sufficient financial resources for the establishment and proper administration of the merchandise road transport business,

and

(iv) tax clearance certificate or C2 certificate issued by the Revenue Commissioners.

18. Please give details of any bankruptcy or winding-up proceedings with which any of the following is or was involved, indicating relevant dates,

(i) the Applicant, and where applicable;

(ii) any Director or Partner, and

(iii) the Transport Manager.

If there were no such involvement's please write NONE.

Please ensure that the appropriate Statutory Declaration regarding bankruptcy at Appendix I, II or III is completed:

(a) Where the Applicant is an individual the declaration at Appendix I must be completed,

(b) Where the Applicant is a partnership the declaration at Appendix II must be completed,

(c) Where the Applicant is a company the declaration at Appendix III must be completed.

PROFESSIONAL COMPETENCE

19. (a) If Applicant holds a Certificate of Competence, please state the number of the Certificate:_____________________________________________________

(b) If Applicant wishes to employ a Transport Manager to satisfy the requirement of professional competence, please sta:

Name:___________________________________________________________

Private Address:_________________________________________________________

Home Telephone No.:___________________________________________________________

Certificate of Competence No.:_______________________________________

(c) What is or will be the total weekly hours of employment of the Transport Manager?:______________________________________________________

(d) If the Transport Manager was the Transport Manager for any other undertaking, please give details as follows:

Place of Employment:_______________________________________________

Period: __________________________________________________________________

YES ( )

NO ( )

If yes, please furnish details

(f) What is the total weekly hours of employment accounted for by the occupation, if any, referred to at (e) above ?:_____________________________________________

The declaration in respect of the employment of the Transport Manager at Appendix IV must also be completed.

Statutory Declaration to be completed where the Applicant is an individual.

I,______________________________,

of _________________________________

do solemnly and sincerely declare that I am neither a bankrupt nor a person in relation to whom there is in existence an arrangement with creditors, whether under the control of a court or otherwise.

Applicant: ________________________________

(Signature)

Declared before me by _________________________________________________ who

is personally known to me (or who is identified to me by ______________________________

of _________________________________________________________ who is personally known to me)

at ______________________________________________________________________

________________________________________________________________________

this ________________

day of ____________________________,

19___________

Name and Address of person witnessing the declaration:

(BLOCK CAPITALS PLEASE)

Signature: _____________________________

A notary public.

Delete whichever is inapplicable

A commissioner for oaths.

A peace commissioner.

A person authorised by law to take and receive statutory declarations.

Statutory Declaration to be completed where the Applicant is a partnership.

I, ______________________________,

of ____________________________________

do solemnly and sincerely declare that I, being a partner in ____________________________

(which said partnership is applying for the grant of a carrier's licence) am neither a bankrupt nor a person in relation to whom there is in existence an arrangement with creditors, whether under the control of a court or otherwise..

(In the case of a partnership each partner should complete this declaration). (Further copies of the declaration may be obtained from the Department of Tourism and Transport).

Applicant: ____________________________

(Signature)

Declared before me by ___________________________________________________ who

is personally known to me (or who is identified to me by ___________________________

of ______________________________________________ who is personally known to me)

at ____________________________________________________________________

this _________________

day of ______________________,

19 ______________

Name and Address of person witnessing the declaration:

(BLOCK CAPITALS PLEASE)

Signature: _____________________________

A notary public.

Delete whichever is inapplicable

A commissioner for oaths.

A peace commissioner.

A person authorised by law to take and receive statutory declarations.

Statutory Declaration to be completed where the Applicant is an company.

I, _____________________________,

of ___________________________________

do solemnly and sincerely declare that neither I being the Secretary of

_____________________________________________________________________________ Limited/plc (applicant for the grant of a carrier's licence) nor any director, manager, or officer of the said Company has been a secretary, director, manager or officer of a company which has been wound up by the

High Court (other than ___________________________________________________

_____________________________ who was involved in _______________________ as being a company which was wound up by the High Court).

Applicant: _____________________________

(Signature)

Declared before me by _________________________________________________ who

is personally known to me (or who is identified to me by _____________________________

of ______________________________________________who is personally known to me)

at ____________________________________________________________________

this _______________

day of ___________________________,

19 __________

Name and Address of person witnessing the declaration:

(BLOCK CAPITALS PLEASE)

Signature: ______________________________

A notary public.

Delete whichever is inapplicable

A commissioner for oaths.

A peace commissioner.

A person authorised by law to take and receive statutory declarations.

Statement to be completed in regard to employment of Transport manager.

I, ______________________________,

of __________________________________

do solemnly and sincerely declare that (name of Transport Manager) ____________________

_____________________________________ of (home address) ____________________

is employed as Transport manager to continuously and effectively manage the merchandise road transport operations

of (name of applicant) ________________________________________________________

(Name of Transport manager) ____________________________________________ has full responsibility

for the day-to-day running of the merchandise road transport business.

Date from which Transport Manager commenced or will commence employment: __________

Signed: ______________________________

Position in employ of Applicant:

Date: ________________________________

In the case of an application from an individual, this statement must be signed by that individual.

In the case of an application from a partnership, this statement must be signed by each of the partners.

In the case of a limited company or other body corporate, this statement must be signed by a Director, Company Secretary or other authorised officer of the company and the person signing this statement should indicate his/her status.