Road Haulage Operator'S Licence Application Form - Ireland Department Of Transport, Tourism And Sport Page 2
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6Section 3
Details of Sole Trader, Directors or others in the business
(see Note 3 in the Guide)
3A
3B
Name______________________________
Name_______________________________________
Address____________________________
Address_____________________________________
___________________________________
____________________________________________
Mobile_____________________________
Mobile______________________________________
Email______________________________
Email_______________________________________
PPSN______________________________
PPSN_______________________________________
Date of Birth________________________
Date of Birth_________________________________
Position in firm______________________
Position in firm_______________________________
3C
3D
Name______________________________
Name______________________________
Address____________________________
Address____________________________
___________________________________
___________________________________
Mobile_____________________________
Mobile_____________________________
Email______________________________
Email______________________________
PPSN______________________________
PPSN______________________________
Date of Birth________________________
Date of Birth________________________
Position in firm______________________
Position in firm______________________
Office Use Only
Section 4
Vehicles to be used under the Licence
(see Note 4 in the Guide)
Registration number
Maximum
Date vehicle
Date vehicle
Certificate of
authorised
taxed until
insured until
Roadworthiness
weight
valid until
4A
4B
4C
4D
4E
If necessary, continue on a separate page, to be signed and dated by the applicant
4F Every operator must have adequate parking spaces and operating premises in the State. Please tick box to
confirm that there is an adequate operational base and parking for every vehicle on the licence:
4G Tick box to confirm that every vehicle to be used under the licence has a currently calibrated tachograph :
Office Use Only
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