CREDENTIAL REPLACEMENT
This form, and additional information, is available at: www.nyc.gov/tlc
This form must be used to request replacement credentials. TLC replacement credentials can be requested if prior
credentials have been lost or damaged, require a photo update, or after a change in the Licensee’s name. Please review
the Credential Replacement checklist before submitting this form. This application can only be submitted by making an
appointment on the TLC website.
□ Photo Update
Update TLC Driver License photo. For non-NY State licensed drivers only; NYS licensees must
use the NY State form available on the TLC website. The replacement TLC license will be issued
at the Long Island City office; and you must surrender your existing TLC license.
There is a twent
y
-five dollar
(
$25.00
)
fee for a credential photo update.
TLC Driver License No. Print Name Signature Date (mm/dd/yyyy)
□ Replacement
Request replacement credentials that were lost, stolen, damaged or mutilated, confiscated, or
were never received in the mail (applies to TLC Driver’s License only).
There is a twent
y
-five dollar
(
$25.00
)
fee to replace credentials.
□ Lost
□ Stolen
□ Damaged / Mutilated
□ Confiscated
□ Decal Replacement
□ Lost in mail
(driver license only)
□
TLC Driver’s License No.
□
SHL Rate Card
□
FHV Decal Sticker (Enter FHV driver license No.)
□
Medallion Tin
□
SHL Permit No. (no fee)
□
Medallion Rate Card (no fee)
Print Name Signature Date (mm/dd/yyyy)
□ Name Change
You must update your TLC Driver’s License and/or For-Hire Vehicle (FHV) License after
completing a legal change to your name. You must submit proof of the legal name change.
There is a twent
y
-five dollar
(
$25.00
)
fee to replace credentials after a name chan
g
e.
TLC Driver’s License
FHV License (Decal, Blue Sticker, Diamond)
□ State issued Driver’s License
(required)
□ Petition of Name Change
□ Marriage Certificate
□ Divorce Papers
□ Certificate of Naturalization
□ Passport with new name
□ Permanent Resident Card I-551
□ U.S. Employment Authorization
Card
□ Social Security Card
(if number has been changed)
I understand that when submitting a name change, I must surrender my old TLC driver’s
license. I have legally changed my name from:
X
Print your former name exactly as it appears on your documents / ID card.
X
Print “NEW” name exactly as it appears on your documents / ID card.
Print Name (new name) Signature (new name) Date (mm/dd/yyyy)
INTERNAL USE ONLY
Processed by: Date (mm/dd/yyyy)
Instructions: Please read the below, Credential Requirement checklist(s), carefully before submitting your application.
You must schedule an appointment on the TLC website to submit this document at the Long Island City office.
Money Orders must be made payable to “NYC Taxi and Limousine Commission” or “NYC TLC.”
Update Photo on a TLC Driver License:
Applies to non-New York State licensed drivers only;
NYS licensees use the NY licensee form on TLC’s
website. To update a TLC Driver License photo, you
must visit the TLC’s Long Island City office. A new
photograph will be taken, and new credentials issued to
you at the office. You will be required to surrender your
previous TLC Driver’s License. The below is required:
□ A completed Credential Replacement request form.
□ The existing TLC Driver’s License.
□ Twenty-five dollars ($25.00), payable by Debit /
Credit Card, or Money Order; cash is not accepted.
TLC Driver License Replacement:
If a TLC Driver License was lost, stolen, damaged /
mutilated, or confiscated, it must be replaced. A new
TLC Driver License will be issued upon submitting a
Credential Replacement request form at the TLC’s Long
Island City office. The below is required:
□ A completed Credential Replacement request form.
□ A copy of the Licensee’s government issued photo
ID / Driver’s License. Out of state drivers must
also provide a DMV abstract dated within 30 days of
the TLC credential replacement request.
□ Note: If providing a NYS DMV Interim Driver’s
License, you must provide an additional Photo ID.
□ Twenty-five dollars ($25.00), payable by Debit /
Credit Card, or Money Order; cash is not accepted.
Please Note: Replacement of a TLC Driver’s license
that was not received / possibly “lost in the mail,” will
occur at no charge, if:
At least ten (10) days has passed after the date
the license was mailed by TLC, and
Not more than sixty (60) days has passed after
the date the license was mailed by TLC.
For-Hire Vehicle (FHV) Decal Replacement:
If a TLC decal sticker is unreadable, or has been
removed and the word “void” is displayed; a
replacement decal must be requested. If a window
displaying a decal sticker is replaced, a replacement
decal must also be requested. The below is required:
□ A completed Credential Replacement request form.
□ A copy of the Vehicle Owner’s government issued
photo ID / Driver’s License.
□ If using a representative, a completed and notarized
TLC “Power of Attorney” form; and a copy of the
representative’s government issued photo ID.
□ Twenty-five dollars ($25.00), payable by Debit /
Credit Card, or Money Order; cash is not accepted.
SHL Permit & Rate Card / Medallion Rate Card & Tin:
□ A completed Credential Replacement request form.
□ A copy of the Owner’s government issued photo ID /
Driver’s License.
□ If using a representative, a completed and notarized
TLC “Power of Attorney” form; and a copy of the
representative’s government issued photo ID.
□ Original Medallion Rate Card (Medallion Tin
replacement).
□ If applicable, twenty-five dollars ($25.00); see fees
below, payable by Debit / Credit Card, or Money
Order; cash is not accepted:
Street Hail Livery (SHL) Permit -- No fee
Street Hail Livery (SHL) Rate Card -- $25.00
Medallion Rate Card – No fee
Medallion Tin -- $25.00
Name Change on a TLC Driver License and / or For-
Hire Vehicle (FHV) License:
After legally changing your name, you must update your
TLC credentials (Driver and Vehicle License(s), if
applicable) at the TLC’s Long Island City office. New
credentials will be issued at the LIC office. The below is
required:
□ A completed Credential Replacement request form.
□ State issued Driver’s License showing the “new”
name and one (1) of the following (in new name):
□ Petition of Name Change;
□ Marriage Certificate;
□ Divorce papers;
□ Certificate of Naturalization;
□ Passport with “new” name;
□ Permanent Resident Card I-551;
□ U.S. Employment Authorization Card.
For-Hire Vehicle License name change also requires:
□ Vehicle Registration with new name, and
□ FHV insurance with new name.
□ Twenty-five dollars ($25.00), payable by Debit /
Credit Card, or Money Order; cash is not accepted.
