Application for the review of a Premises Licence or Club Premises Certificate under the Licensing Act 2003 : Application for Review

Application for Review

This form can be completed on-line.

Before completing this form please read the guidance notes below. Use additional sheets if necessary and please write legibly in BLOCK CAPITALS. You may wish to keep a copy of the completed form for your records.

Notes for Guidance

1. An applicant's agent (for example solicitor) may sign the form on their behalf provided that they have actual authority to do so.

2. This is the address that we shall use to correspond with you about this application. (Refers to Contact Name/Address)

The fee for this application is £21 and must be included with the submission of the application.

Once PRINTED please ensure the form is signed and sent to:

Public Health and Licensing, Park House, North Street, Horsham, West Sussex, RH12 1RL.

Schedule 8 :

Application for the review of a Premises Licence or Club Premises Certificate under the Licensing Act 2003

I

[Insert name of applicant]

Title mandatory field

Forenames mandatory field

Surname mandatory field

Email mandatory field

Please tick one Review option:

apply for the review of a premises licence under section 51

apply for the review of a club premises certificate under section 87 of the Licensing Act 2003 for the club/premises described in Part 1 below

Part 1 - Premises or Club Premises Details

Postal address of premises or club premises if any, or if none the ordinance survey map reference or description.

Premise Name mandatory field

Address Line 1 mandatory field

Address Line 2

Town / Village mandatory field

County

Postcode mandatory field

Ordinance Survey Reference

Description of address

Phone mandatory field

Name of premises licence holder or club premises certificate holder (if known)

Premises Licence Number or Club Premises Certificate Number (if known)