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Fomu za Maombi ya Leseni
Land Transport Regulatory Authority
APPLICATION FOR PRIVATE HIRE (SERVICE PROVIDER) LICENCE
Type of Service:
Period Applied for:
Motor cycle Tricycle Taxi Cab
Ride hailing Ride sharing Special Hire
Any other (Specify) ……………………………………………..
A. PARTICULARS OF AN APPLICANT OF A LICENCE
1. Applicant’s Name in full 🙁 Individual/Company/ Partners, in BLOCK LETTERS)
Postal Address Postcode:
Office Mobile Phone 1: Applicant’s Mobile Phone:
Street: Plot Number: Office Number:
Have you had a previous application
refused/suspended or revoked?
If Yes, state when and why previous application refusal, licence suspension or revocation was made
B. DOCUMENTS TO BE PROVIDED DURING APPLICATION
2 First application shall be accompanied by the items listed below:
(a) Vehicle Registration Card ,
(b) A valid certificate of motor vehicle road worthiness and
(c) Certificate of Incorporation (in case of a body corporate).
(d) Special Hire should install VTS approved by the Authority
I/We hereby declare that to the best of my/our knowledge and belief all the information
provided in this application is true.
Full Name: Signature: