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

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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.

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