Fillable Printable Application for a Transfer and/or Affiliation - New York City

Application for a Transfer and/or Affiliation - New York City

Licensing and Standards Division

32-02 Queens Boulevard

Long Island City, NY 11101-2324

Please visit our website for Staten

Island office information

BASE, PLATE AND VEHICLE TRANSFER AND AFFILIATION APPLICATION

FHV, PARATRANSIT & COMMUTER VAN

Please read the steps below & review the TLC Vehicle Application Requirements and Checklist carefully before submitting your application to

determine the requirements needed to license your vehicle with the TLC. The documents needed for each transaction may be different depending

on the transaction type – so review carefully.

STEP 1

HOW TO SUBMIT AN APPLICATION FOR A TRANSFER AND/OR AFFILIATION

Visit your Base to have them request an appointment to submit your “TLC Vehicle Application Form.” The Base/Authority must

STEP 3

REGISTRATION / INSPECTION

STEP 4

PASS INSPECTION! START OPERATING!

Plate Transfers

Once your application has been processed at the counter you will be given a plate letter if you need new T&LC plates. You must go

to the New York State (NYS) DMV with the “Plate Letter” and get TC license plates. As soon as you obtain your TC license plates and

registration let the Base know! The Base must request the inspection appointment on our Web site. After the Request is received,

we will schedule the vehicle for an inspection. We will send the inspection appointment to your Base via e-mail. If you already have

plates (out of state and outside of NYC plates) your inspection will be scheduled when your application has been processed by the

TLC staff.

STEP 2

SUBMIT AN APPLICATION

On the day of your appointment, You will need to bring a complete application package. This includes:

A printout of your Appointment Confirmation.

A completed “Base, Plate and Vehicle Transfer and Affiliation Application Form.”

CLEAR AND LEGIBLE COPIES of all required documents. Incomplete application packages will NOT be accepted. Applicants are

responsible for reviewing ALL requirements listed on this checklist.

All required payments.

ALL FEES ARE NON-REFUNDABLE.

You must be on time. If you are late you will be required to request a new appointment through your Base.

The applicant must be the registered owner or direct lease holder of the vehicle. Please provide current registration, lease

agreement, certificate of origin or your title (front and back) as proof. If you are not the owner and/or officer, you must have a

signed Power of Attorney from the owner. A Power of Attorney is allowed for Base transfers, Plate transfers and Vehicle

Transfers.

Drop off service is only available for base transfers and plate transfers. Vehicle transfers require an appointment. SHL transactions

will not be processed through the Drop off service.

Hours for Drop off are 9 AM to 11 AM. The window opens at 9 AM and closes promptly at 11 AM. Late submissions will not be

allowed. Hours for Pick up are 2 PM and 4 PM.

You must use the same address on your TLC application, Declaration Page, FH-1 and DMV registration. If your address is a Post Office

Box you must provide a legal address and a recent utility bill or bank statement or lease from your landlord as proof of your legal

address. Cell phone bills are not accepted as proof of address.

Notes:

Street Hail Livery - SHL (IF APPLICABLE):

Any Transaction that involves an SHL Permit will require the SHL Permit Holder to be present with the FHV Owner at the

time of the appointment.

A Power of Attorney for SHL transactions will not be accepted.

To operate a vehicle as an SHL it must be attached to an SHL Permit.

The vehicle MUST be Hacked Up BEFORE going for an inspection.

Yellow vehicles are not allowed to operate as a For–Hire Vehicle.

A vehicle found operating without current permits or license will be summonsed and may be seized by Enforcement.

The Vehicle cannot operate For-Hire until it has completed the inspection process.

schedule an appointment on our website at www.nyc.gov/tlcappointment.

BASE, PLATE AND VEHICLE TRANSFER AND AFFILIATION APPLICATION

REQUIREMENTS AND CHECKLIST

FHV, PARATRANSIT AND COMMUTER VAN

Current for-hire Insurance Certificate (FH-1). Insurance must be issued in the applicant’s name.

Current Insurance Declaration Page directly from your insurance company showing levels of insurance coverage.

Insurance policy must be current.

Current DMV registration, Bill of Sale, Leasing Agreement, Certificate of Origin or Certificate of Title (Front and Back).

NOTE: Vehicles licensed out of state must provide DMV registration showing seating capacity.

Government Issued photo I.D. of applicant. State issued driver’s license preferred.*(see note below)

DMV receipt for plates (FS-6T) or new registration with vanity plates documenting that plates have been

surrendered or destroyed.

To verify business entities: Filing Receipt & Corporate Resolute (minutes) electing officers, Business or

Partnership Certificate, (whichever is appropriate); and Lease Agreement, (if applicable).

(See page 2 of 2 for more information)

Social Security Card of applicant. *(see note below)

Page 1 of 2

Zero outstanding judgments to the TLC, NYS DMV Traffic Violations Bureau (TVB), Department of Finance (DOF)

Parking Violations, DOF Red Light Bureau (i.e., unpaid tickets) and Commercial Motor Vehicle Tax (CMVT).

FEES can be paid by Money Orders, Certified Checks, Master Card, Visa, AMEX or Discover. Money Orders and Certified Checks are payable to:

NYC Taxi & Limousine Commission.

YES

Licensing and Standards Division

32-02 Queens Boulevard

Long Island City, NY 11101-2324

Please visit our website for Staten

Island office information

*Please note: Copies of these documents are not required if the information previously submitted to the TLC for the most current & existing vehicle license

has not changed.

TRANSFER FEE: Twenty Five ($25) transfer fee for each Transfer type. VEHICLE TRANSFERS ONLY – Seventy-Five

($75) Inspection fee also required, depending on the transaction type. See below – “INSPECTION FEE”

INSPECTION FEE: Seventy-Five ($75) required if vehicle has 500 miles or more recorded on the odometer. New

applicants must pay an inspection fee together with their completed application fee of $550. If a new

application is submitted at LIC or Staten Island Inspection, fees are REQUIRED before your visit to our TLC

Inspection facilities for an Inspection.

Note: SHL affiliated vehicles are not required to pay an inspection fee.

Stretch limousine only: In addition to all of the above requirements, limousine applicants must also bring a copy

of the Coach Builder’s letter as proof that the vehicle was stretched by a manufacturer- certified stretch limo

builder.

STRETCH LIMOUSINE ONLY

FOR FHV AND COMMUTER VAN ONLY

STRETCH LIMOUSINE, COMMUTER VAN AND PARATRANSIT

Yo u must p rov ide C LEA R c op ies o f all requi red do cu ment s. If y ou d o not prov ide

all requi remen ts on t he da te yo u su bmi t yo ur app licat io n t o t he T LC, yo ur

a ppl icati on wil l b e deni ed . AL L F EE S ARE NO N REF UN DA BL E.

ALL TYPES

Stretch limousine vehicle(s), Commuter Van and Paratransit vehicles must have a N.Y.S. Department of

Transportation Inspection form (MC300) showing vehicle has been inspected. The front and back page (defect

report) of the document is required. The defect report must be provided if vehicle inspection report indicates a

denial. (The inspection report is valid for one (1) year, and it must be current at time of application). If NYS DOT

operating authority license is not required, a NYS DOT exemption letter is needed.

Stretch limousine vehicle(s), Commuter Van and Paratransit vehicles that are required to have NYS

DOT carrier authority, can only be operated by drivers that have an ACTIVE 19A Status.

Each of the above are also required to submit the photo identification and social security cards of each of its stock

holders or members or managing members, whichever is applicable. They also need to submit the

IRS issued CP-575 Notice or 147-C letter for the business.

Along with all required items listed on the Vehicle Application Checklist, businesses must also

include the following documents for your business type:

Document Requirements to Verify Businesses Entities

If the Applicant is a partnership, it must file with its application a certified copy of the partnership

certificate from the clerk of the county where the partnership’s principal place of business is

located.

Partnerships

If the Applicant is a corporation, it must file with its application: A certified copy of its certificate of

incorporation; a list of officers and shareholders; a certified copy of the minutes of the meeting at

which the current officers were elected.

Corporations

If the Applicant is a limited liability company, it must file with its application: A copy of its articles of

organization; a copy of its operating agreement; a list of the members, with the percentages of the

Applicant owned by each. We cannot accept an election of officers form for an LLC as they do not

have shares in an LLC only percentages are assigned.

Limited

Liability

Companies

(LLCs)

Page 2 of 2

Vehicle Insurance Requirements

Please see the chart below for the minimum insurance levels your vehicle must possess based on the type of vehicle you

own and the vehicle’s seating capacity (as per TLC rule unless otherwise noted).

Vehicle Type Seating Capacity Minimum Insurance Levels

Livery Vehicle

Black Car

Luxury Limousine

1-8 passengers

9-15 passengers

16-20 passengers

$100,000 per person

$300,000 per occurrence

$200,000 PIP*

$1.5 Million per occurrence

$200,000 PIP*

**See Note

$5 million occurrence

$200,000 PIP*

**See Note

1-8 passengers

9-15 passengers

16-20 passengers

$500,000 per person

$1 million per occurrence

$200,000 PIP*

**See Note

$1.5 million occurrence

$200,000 PIP*

**See Note

$5 million occurrence

$200,000 PIP*

**See Note

Commuter Van

1-12 passengers

13-20 passengers

$100,000 per person

$300,000 per occurrence

$50,000 property damage

$100,000 per person

$500,000 per occurrence

$50,000 property damage

Paratransit Vehicle

Insurance levels for paratransit vehicles are those required by New York State.

Please refer to the New York State Department of Transportation (NYSDOT)

Passenger-Insurance Requirements for more information.

*Personal Injury Protection (PIP)

**Note: Only a vehicle owned directly by the Base can use a Base Umbrella Policy to meet any portion of the TLC mandated liability

insurance requirements. The Declaration Page of the Base policy presented MUST include a schedule of Vehicle Identification Numbers

(VINS) that are covered. The policy must have insurance levels that bring the vehicle up to all agency insurance requirements and the

policy must cover any and all accidents incurred by the vehicle. There can be no exclusionary language in the policy that limits liability or

coverage for the vehicle. The TLC may request a full copy of the Base policy to confirm coverage and this could delay the processing of

your application.

Licensing and Standards Division

32-02 Queens Boulevard

Long Island City, NY 11101-2324

Please visit our website for Staten

Island office information

OLD VEHICLE INFORMATION

(Fill out if requesting a Vehicle Transfer only)

VEHICLE ID #

PLATE #

YEAR

MAKE

Name

StateCity

Mailing Address

D/B/A

Cell phone # Other Telephone #

Zip

EIN or SS#

Licensing and Standards Division

32-02 Queens Boulevard

Long Island City, NY 11101-2324

Please visit our website for Staten

Island office information

Corporation

Sole Proprietorship

Partnership

Business Type

(please check one)

Email Address

(Required)

APPLICANT INFORMATION

NEW VEHICLE INFORMATION

Note: If vehicle has a NYS DOT operating authority (MC 300), a Visual Inspection is required, no fee needed.

YES NO

YEAR

Page 1 of 4

VEHICLE ID #

PLATE #

SEATING CAPACITY

MAKE

HAS THIS VEHICLE BEEN STRETCHED?

IF YES, GIVE THE NAME OF THE COACH BUILDER:

TLC License number:

TLC H Record number:

YES NOIS THIS VEHICLE WHEELCHAIR ACCESSIBLE?

FOR-HIRE VEHICLE

PARATRANSIT COMMUTER VAN

Wheelchair Accessible Vehicle Non Wheelchair Accessible Vehicle

Street Hail Livery Vehicle ONLY

Vehicle Classification:

Please Note: A Wheelchair Accessible SHL Permit MUST affiliate a Wheelchair Accessible Vehicle.

TYPE OF VEHICLE:

Transfer Plates

Affiliate vehicle to SHL PermitTransfer Vehicle

Transfer vehicle to another base

TRANSACTION TYPE:

BASE, PLATE AND VEHICLE TRANSFER AND AFFILIATION APPLICATION

FHV, PARATRANSIT & COMMUTER VAN

Residence Address (No P.O. Boxes)

City State Zip

Page 2 of 4

Wheelchair Accessible Vehicle (WAV) Non-Wheelchair Accessible Vehicle (Non-WAV)

NEW BASE or COMMUTER VAN AUTHORITY

OLD BASE or COMMUTER VAN AUTHORITY

NEW and/or CURRENT PERMIT AFFILIATION -- STREET HAIL LIVERY PERMIT AFFILIATIONS ONLY

OLD PERMIT AFFILIATION -- STREET HAIL LIVERY AFFILIATIONS ONLY

ALL vehicles licensed by the Taxi and Limousine Commission must be current and affiliated with a licensed base in order to

operate. These vehicles can only be operated by drivers with valid TLC licenses who are permitted to operate that type of

vehicle. You must submit an affirmation form completed by a base representative . See Affirmation Form on page 4.

Base Owner: Please review the rules and regulations that mandate affiliation and

operation of this vehicle.

Permit Holder: Please review the rules and regulations that mandate affiliation and

operation of this vehicle.

Has this Base Owner been notified that this vehicle is being removed?

YES NO

Has this Permit Owner been notified that this vehicle is being removed?

YES NO

BASE TRANSFER OR AFFILIATION INFORMATION

In order to affiliate a vehicle with a Street Hail Livery Permit the vehicle must have a underlying FHV, PARATRANSIT OR COMMUTER VAN LICENSE. You

must submit a signed affirmation form completed by the SHL Permit Holder. See Affirmation Form on page 4.

TYPE OF SHL PERMIT:

BASE / AUTHORITY NAME

BASE LICENSE #

BASE / AUTHORITY NAME

BASE LICENSE #

STREET HAIL PERMIT TRANSFER OR AFFILIATION INFORMATION

If this section is complete, you must submit an affirmation complete by the Permit Holder.

SHL PERMIT ENTITY NAME

SHL PERMIT #

SHL PERMIT ENTITY NAME

SHL PERMIT #

Please Note: A Wheelchair Accessible SHL Permit MUST affiliate a Wheelchair Accessible Vehicle.

1.- Does the vehicle have less than 500 miles recorded on the odometer?

2.- Is the vehicle higher than 7 feet?

3.- Does this vehicle weigh over 8,500lbs?

If you answered YES to ANY of the above questions, you will be scheduled for a Visual Inspection at one of our TLC Inspection facilities. On questions 2 or

3, on the day of your inspection you will be required to show proof of a Passed DMV inspection within the last four (4) months (which you can obtain at

any local licensed NYS DMV inspection facility).

YES

If you answered NO to question 1, an inspection fee of seventy-five ($75) is required.

The mileage will be verified on the day of your inspection.

LIST ALL OWNERS, PARTNERS, OFFICERS AND STOCKHOLDERS

(Use additional page if necessary)

Name:

Signature:

Title:

Date:

NAME:

MAILING ADDRESS:

CITY:

STATE:

TELEPHONE #:

ZIP:

SS #: DRIVER LICENSE #:

# OF SHARES:

Secretary (Print) Secretary (Signature) Date

Corporation

Sole Proprietorship

Partnership

For Corporation or Partnership,

please check if you are:

Treasurer

President

Vice President

Secretary

Business Type (please check one):

( )

Shareholder

At a special meeting, stockholders of

nominated and duly elected by unanimous vote the officers listed above.

For Election or Change of Officers use only

Company Name

Page 3 of 4

NAME:

MAILING ADDRESS:

CITY:

STATE:

TELEPHONE #:

ZIP:

SS #:

DRIVER LICENSE #:

# OF SHARES:

For Corporation or Partnership,

please check if you are:

Treasurer

President

Vice President

Secretary

( )

Shareholder

NAME:

MAILING ADDRESS:

CITY:

STATE:

TELEPHONE #:

ZIP:

SS #: DRIVER LICENSE #:

# OF SHARES:

For Corporation or Partnership,

please check if you are:

Treasurer

President

Vice President

Secretary

( )

Shareholder

NAME:

MAILING ADDRESS:

CITY:

STATE:

TELEPHONE #:

ZIP:

SS #:

DRIVER LICENSE #:

# OF SHARES:

For Corporation or Partnership,

please check if you are:

Treasurer

President

Vice President

Secretary

( )

Shareholder

By initialing this box I am affirming that I am the same person who signed the affirmation statement below, that I have read and reviewed this application

and that there is an existing and current vehicle license issued by the TLC and that there have been no changes to the Business Entity structure for that current & existing

vehicle license since the last submission to the TLC. Copies of a principals DMV license and Social Security card are therefore not needed for this transaction.

“I do hereby affirm, under penalty of law, that I have examined and reviewed the information in the submitted form(s) or application(s), including any supplemental

form(s) and/ or document(s) and that these document(s) and or statement(s) do not contain any untrue statement(s) nor are they missing any material information

and/ or fact(s). If the box above has been initialed then I am also affirming that there have been no changes to the Business Entity structure for the most current & existing

vehicle license since the last submission to the TLC. I also acknowledge and understand that any false statement(s) submitted is punishable under the law and may result in

a denial of an application or the suspension or revocation of an existing license/permit.

I further affirm and acknowledge that I have read all rules applicable to my license and that I understand that I am are required to follow and comply with these rules.

Failure to do so may result in the issuance of a summons that could result in the imposition of points, fines, a suspension or revocation of my license.”

NOTE: This page does not replace a filing receipt for a Corporation or a member breakdown for a LLC

Affirmation Form

Applicant Name

Street Hail Livery

Permit Owner

(if Applicable)

Base Owner

I, ,

(check one)

Owner

Partner

Officer

Stockholder

In order to process an application a signed affirmation must be submitted for each required entity.

Signatures must be original and signed by hand. No copied or stamped signatures.

Entity Name (either applicant name, base, or SHL permit holder)

Name

Page 4 of 4

I understand that:

“I hereby affirm, under penalty of law, that I have examined and reviewed the information in the submitted form(s) or

application(s), including any supplemental form(s) and/ or document(s) and that these document(s) and or statement(s) do

not contain any untrue statement(s) nor are they missing any material information and/ or fact(s) according to the rules

applicable to my license type. There has been no changes to the Business Entity structure for the most current & existing

vehicle license since the last submission to the TLC, if applicable. I also acknowledge and understand that any false

statement(s) submitted is punishable under the law and may result in a denial of an application or the suspension or

revocation of an existing license/permit.

I further affirm and acknowledge that I have read all rules applicable to my license and that I understand that I am are required

to follow and comply with these rules. Failure to do so may result in the issuance of a summons that could result in the

imposition of points, fines, a suspension or revocation of my license.”

Print Name Signature Date

For-Hire

Commuter Van Para Transit

LICENSE TYPE

Print Name Signature Date

with the vehicle identification number: