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Taxi or Private Hire Car Licence – Insurance Provider Form

Orkney Islands Council

Civic Government (Scotland) Act 1982

Certificate of Vehicle Insurance – to be completed and signed by insurance provider.
Name of insured:
Address of insured:
Name of insurer:
Address of insurer:
Policy Reference No:
Registration number(s) of vehicle(s) insured:
Limitation on drivers:

I certify that the above-mentioned insured is insured under a policy of motor insurance in accordance with the above details for the use of the vehicle(s) mentioned as a taxi/private hire car* and that my company will inform the Head of Legal Services, Orkney Islands Council, Council Offices, Kirkwall KW15 1NY in the event of the above-mentioned policy lapsing or the cover provided by the policy of insurance altering or ceasing to be of effect.
Date:
Signature:
For and on behalf of:
Insurance broker’s address if applicable:
Name of person to be contacted in case of enquiry:
Telephone number:

*Delete as appropriate. Form Version: 2018-05-25.

IMAGE: The page presents a blank Taxi or Private Hire Car Licence – Insurance Provider Form from Orkney Islands Council. It contains a table for the insured person’s name and address, insurer’s name and address, policy reference number, vehicle registration numbers, and driver limitations, followed by a vehicle insurance certification statement and blank fields for the date, signature, organisation represented, insurance broker’s address, contact person, and telephone number.