Temporary Event Notice : Application Details

Your Details

Before completing this notice please read the on line guidance notes.

If you have completed an online application and paid online then you need take no further action.

If you are printing off the application form or have completed a word document application and intend to pay by cheque then you must send two copies of this notice to the licensing authority and additional copies must be sent to the chief officer of police and the local authority exercising environmental health functions for the area in which the premises are situated. In both cases the licensing authority will give you written acknowledgement of the receipt of the notice.

PLEASE NOTE that in all cases the application fee is non refundable.

You should keep a copy of the completed notice for your records.

If you wish a word copy of the application form to complete by hand then contact licensing@horsham.gov.uk with your full name/address/contact number and email address.

I, the proposed premises user, hereby give notice under section 100 of the Licensing Act 2003 of my proposal to carry on a temporary activity at the premises described below.

The Personal Details of Premises User (Please read note 1)

Your Name

Title mandatory field

Forenames mandatory field

Surname mandatory field

Date Of Birth mandatory field

Date Of Birth Day Date Of Birth Month Date Of Birth Year

Place Of birth mandatory field

NI Number mandatory field

Fax Number

Email Address mandatory field

Address Line 1 mandatory field

Address Line 2

Address Line 3

City / Town mandatory field

County

Postcode mandatory field

Telephone (Daytime)

Telephone(Evening)

Telephone(Mobile)

Previous Name(s)

(Please enter details of any previous names or maiden names, if applicable. Please continue by writing details on a separate sheet if necessary)

Title

Forenames

Surname