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Application for Taxicab Owners License and/or Taxicab Driver’s License

Pursuant to By-Law 050-2009

Date Submitted:

Type of Application:

Name:

Phone Number:

Mailing Address:

Email:

Date of Birth:

Citizenship:

Ontario Driver's License Number:

Class of Driver's License:

Suspensions:

Cancellations:

Other:

Contact Information for Two References:

Name of Taxicab Company:

Driver Employed:

Insurance Company:

Policy Number:

Please attach Certificate of Insurance:

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Safety Standard Certificate Number:

Please attach Safety Standard Certificate:

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Vehicle License Plate Number:

License Plate Issued:

Vehicle Make:

Model:

Year:

Date:

Applicant’s Signature:

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