1. Full Name of Applicant:

2. Business or Trade Name (if any):

3. Description of Applicant:

( ) LIMITED COMPANY

( ) 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?

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

(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.

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?

(b) Radioactive materials?

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?

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

(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?

14. In relation to the carriage of radioactive materials:

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

(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"?

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

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

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.

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),

(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,

(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.

(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.

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: __________________________________________________________________

(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.