Premises Application

8/10/2019 Premises Application

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[Insert name and address of relevant licensing authority and its reference number (optional).]

Application for a premises licence to be granted

under the Licensing Act 2003

PLEASE READ THE !LL!"#$% #$STR&'T#!$S #RST

Before completing this form please read the guidance notes at the end of the form. If you are completingthis form by hand please write legibly in block capitals. In all cases ensure that your answers are inside the

boxes and written in black ink. Use additional sheets if necessary.

You may wish to keep a copy of the completed form for your records.

#("e

(Insert name(s) of applicant)

appl) for a premises licence under section *+ of the Licensing Act 2003 for the premises described in

Part * belo, -the premises. and #(,e are ma/ing this application to )ou as the releant licensing

authorit) in accordance ,ith section *2 of the Licensing Act 2003

Part * 1 Premises Details

Postal address of premises or, if none, ordnance survey map reference or description

Post to,n Postcode

elephone number at premises !if any"

#on$domestic rateable value of premises

Part % $ &pplicant 'etails

Please state whether you are applying for a premises licence as Please tick as appropriate

a" an individual or individuals ( please complete section !&"

b" a person other than an individual (

i. as a limited company please complete section !B"

ii. as a partnership please complete section !B"

iii. as an unincorporated association or please complete section !B"

iv. other !for example a statutory corporation" please complete section !B"

c" a recognised club please complete section !B"


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d" a charity please complete section !B"

e" the proprietor of an educational establishment please complete section !B"

f" a health service body please complete section !B"

g"

ga"

a person who is registered under Part % of the )are

*tandards &ct %+++ !c-" in respect of an independenthospital in ales

a person who is registered under )hapter % of Part of the /ealth and *ocial )are &ct %++0 !within the

meaning of that Part" in an independent hospital in

1ngland

please complete section !B"


h" the chief officer of police of a police force in 1ngland

and ales


( If you are applying as a person described in !a" or !b" please confirm2

Please tick yes

I am carrying on or proposing to carry on a business which involves the use of the premises forlicensable activities3 or

I am making the application pursuant to a

statutory function or

a function discharged by virtue of /er 4a5esty6s prerogative

-A.#$D##D&AL APPL#'A$TS !fill in as applicable"

4r4rs 4iss 4s

7ther itle !for

example, 8ev"

Surname

irst names

I am 0 years old or over Please tick yes

)urrent postal address if

different from premises

address

Post town Postcode

Da)time contact telephone number

E4mail address

-optional.


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SE'!$D #$D##D&AL APPL#'A$T !if applicable"

4r4rs 4iss 4s 7ther itle !forexample, 8ev"

Surname

irst names

I am 0 years old or over Please tick yes

)urrent postal address ifdifferent from premises

address

Post town

Postcode

Da)time contact telephone number

E4mail address

-optional.

-5. !THER APPL#'A$TS

Please proide name and registered address of applicant in full6 "here appropriate please gie an)

registered number6 #n the case of a partnership or other 7oint enture -other than a bod) corporate.8

please gie the name and address of each part) concerned6

#ame

&ddress

8egistered number !where applicable"

'escription of applicant !for example, partnership, company, unincorporated association etc."

elephone number !if any"

1$mail address !optional"


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Part 3 !perating Schedule

hen do you want the premises licence to start9'' 44 YYYY

If you wish the licence to be valid only for a limited period, when do you

want it to end9

'' 44 YYYY

Please give a general description of the premises !please read guidance note "

If :,+++ or more people are expected to attend the premises at any one time,

please state the number expected to attend.

hat licensable activities do you intend to carry on from the premises9

!Please see sections and - of the ;icensing &ct %++< and *chedules and % to the ;icensing &ct %++


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Proision of late night refreshment !if ticking yes, fill in box I"

Suppl) of alcohol !if ticking yes, fill in box ?"

#n all cases complete bo9es :8 L and ;

A

Pla)s

*tandard days and timings

!please read guidance note

@"

"ill the performance of a pla) ta/e place indoors

or outdoors or both 1 please tic/!please read

guidance note %"

Indoors

7utdoors

'ay *tart =inish Both

4on

Please gie further details here !please read guidance note


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5

ilms

*tandard days and timings!please read guidance note

@"

"ill the e9hibition of films ta/e place indoors or

outdoors or both 1 please tic/!please read guidancenote %"

Indoors

7utdoors


4on



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)

#ndoor sporting eents


@"

Please gie further details !please read guidance note


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D

5o9ing or ,restling

entertainments


!please read guidance note

@"

"ill the bo9ing or ,restling entertainment ta/e

place indoors or outdoors or both 1 please tic/!please read guidance note %"

Indoors

7utdoors


4on



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E

Lie music


@"

"ill the performance of lie music ta/e place

indoors or outdoors or both 1 please tic/!pleaseread guidance note %"

Indoors

7utdoors


4on



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Recorded music


@"

"ill the pla)ing of recorded music ta/e place

indoors or outdoors or both 1 please tic/!pleaseread guidance note %"

Indoors

7utdoors


4on



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%

Performances of dance


@"

"ill the performance of dance ta/e place indoors

or outdoors or both 1 please tic/!please readguidance note %"

Indoors

7utdoors


4on



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H

An)thing of a similar

description to that falling

,ithin -e.8 -f. or -g.


!please read guidance note@"

Please give a description of the type of entertainment you will be providing

'ay *tart =inish "ill this entertainment ta/e place indoors or

outdoors or both 1 please tic/!please read guidance

note %"

Indoors

4on

7utdoors

Both

ue



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#

Late night refreshment


@"

"ill the proision of late night refreshment ta/e

place indoors or outdoors or both 1 please tic/

!please read guidance note %"

Indoors

7utdoors


4on



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'!$#'T#!$ T! A #$E $!T E?'EED#$%

LEEL @ !$ THE STA$DARD S'ALE8 &$DER SE'T#!$ *@ ! THE L#'E$S#$% A'T 20038

T! ;A:E A ALSE STATE;E$T #$ !R #$ '!$$E'T#!$ "#TH TH#S APPL#'AT#!$6

Part B 1 Signatures !please read guidance note +"

Signature of applicant or applicantCs solicitor or other dul) authorised agent !see guidance note ".

#f signing on behalf of the applicant8 please state in ,hat capacit)6

*ignature

'ate

)apacity

or 7oint applications8 signature of 2ndapplicant or 2ndapplicantCs solicitor or other authorised agent

!please read guidance note %". #f signing on behalf of the applicant8 please state in ,hat capacit)6

*ignature

'ate

)apacity

)ontact name !where not previously given" and postal address for correspondence associated with this

application !please read guidance note


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. 'escribe the premises, for example the type of premises, its general situation and layout and any

other information which could be relevant to the licensing ob5ectives. here your application

includes off$supplies of alcohol and you intend to provide a place for consumption of these off$supplies, you must include a description of where the place will be and its proximity to the

premises.

%. here taking place in a building or other structure please tick as appropriate !indoors may include

a tent".

Documents

Premises Application