Vehicle Accident Report

Local Government (Miscellaneous Provisions) Act 1976 (“the Act”) Section 50(3) Notification

Without prejudice to the provisions of section 25 of the Act of 1972, the proprietor of a hackney carriage or of a private hire vehicle licensed by a district council shall report to them as soon as reasonably practicable, and in any case within seventy two hours of the occurrence thereof, any accident to such hackney carriage or private hire vehicle causing damage materially affecting the safety, performance or appearance of the hackney carriage or private hire vehicle or the comfort or convenience of persons carried therein.

Section A - the notifier
Section B - the driver
Section C - the vehicle
Section D - the accident
Section E - vehicle damage Please mark only with an ‘X’ the area damaged as a result of the Collision.
Please note that unseen damage may have occurred to the chassis of the vehicle, a photograph of the damage should be included if possible and the completed form sent by email or posted to the Civic Centre, Chesterfield Road South, Mansfield NG19 7BH






























































Section F - injury to the driver
Section G - injury to others

  • Please describe what you believe the injuries are:
Section H - investigative bodies
Section H - investigative bodies
Section J - Applicant Declaration and Caution
    In making this notification, I confirm the following:
    • The information given is true to the best of my knowledge.
    • I/We understand that I/We may be liable to prosecution if I knowingly or recklessly made make a false statement or omit any material particular from this document.

    Use of your information

    The information Mansfield District Council holds about you is used for the purpose of assessing your eligibility for a licence and for the administration of any licence issued to you in accordance with Local Government (Miscellaneous Provisions) Act 1976, Town Police Clauses Act 1847 and any other relevant legislation.

    Under the Freedom of Information Act 2000 or the Environmental Information Regulations 2004, Mansfield District Council may have to release the information contained in this form if asked to do so. The information you provide will be processed in accordance with the Data Protection Act 1998 which protects your personal information. Your personal information may be shared with other departments of the council, other local authorities and government departments and agencies such as the police to prevent and detect fraud, corruption, money laundering and other crimes and to manage your affairs in circumstances where the Data Protection Act allows us to do so. Your personal information will not be released where the law allows.

    After an accident, insurance agencies and investigators often ask us for information about the accident and whether the vehicle and driver are licensed with us. If you would like to give us express permission to disclose relevant information, and speed up the processing of any claim you make, please check below.

  • (Please be aware that even if you do not give us permission, we may still disclose the information where we consider the disclosure is justified and it is allowed under the Data Protection Act 1998.)





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Data protection

The information you supply will be used to enable this request or notification to be carried out and will be handled in accordance with the Data Protection Act 2018. For more information please see our privacy notice.