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Application no.

Application details

Holder Name:

Holder Address:

Correspondence Address:

Number of Households occupying the HMO or House:

Number of People occupying the HMO or House:

Type of receptacle:

Applicant:

Market:

Pitch:

Commodities

Commodities selected

Commodity Information:

List of products and menu items

View application View Environmental Health Form

Requested Hours:

Approved Hours:

Licensable Activities

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Licence Conditions

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Consultation feedback

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Permission required

Unique Access ID:

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Email address

Variation Request

Type of request

Please describe the proposed variation(s) in detail and explain why you consider that they could not have an adverse effect on the promotion of any of the licensing objectives (See Guidance Note 1). This should include whether new or increased levels of licensable activities will be taking place indoors or outdoors (indoors may include a tent):

Date variation to take effect

Structure/Layout Change

Detail of change

Please uploaded an updated version of the premises plan clearly showing proposed layout change

Licence Activities

Licence Holder(s)

Update (Name and Address)

Designated Supervisor

Update (Name and Address)

Premise Trader

Designated Supervisor

Opening Hours

Licence Conditions
Current Conditions

View Conditions

Please detail the conditions you would like to add, amend or remove

If 5,000 or more people are expected to attend the premises at any one time, please state the number expected to attend.

Licence Objectives

Describe any additional steps you intend to take to promote the four licensing objectives as a result of the proposed variation:

a) General - all four licensing objectives (b, c, d and e) (please read guidance note 10)

b) The prevention of crime and disorder.

c) Public Safety

d) The prevention of public nuisance.

e) The protection of children from harm.

Is the premises council-operated?

Is the premises a vessel?

Applicant

Title:

Name

Address:

Over 18?

Telephone

Email Address

Contact details are same as above?

Contact Name

Correspondence Address:

Telephone

Email Address

Licence objectives

This application to review relates to the following licensing objective(s)

If you wish to amend or remove any conditions currently on your licence, please detail this here:

Supporting information

Please provide as much information as possible to support the application:

Please upload any appropiate evidence

Review history

Have they made an application for review relating to the premises before?

Start date:

If representation has been made before relating to the premises, please state what they were and when they were made

Review type

This application is the following type of review:

Designated Premises Supervisor

Name

DOB

Address

Telephone

Personal licence number

Issuing Authority

View representation

Representation

Name

Email Address

Address:

Comment - Please refrain from putting any personal information in your comment Characters remaining:

Is this representation in support of the application?

Yes

Upload document

Please provide a brief description

Accepted file upload types are JPEG, PNG, and PDF only, with the max file size of 11MB.

Representation status change

Status

Comment

Document Upload

Upload Document

Please provide a brief description

Reply all representation

Reply message

Environmental Health Form

Local Authority that your food business registered with.

-------

Date of your last inspection

-------

Food hygiene rating score

-------

List electrical equipment and gas appliances that will be on site and type of generator that will be used. Value

Dates of the latest inspections (Gas Safe inspections, PAT certification)

Value

Method of food production. In addition to your HACCP please provide the following details for this particular event:

how the food is prepared/stored before transit

transportation

storage on site

preparation on site

cooking/reheating

hot/cold holding

serving of food

Please give details of the controls you have in place (e.g. maintaining the cold chain, temperature control, cross contamination control, cleaning, etc.)

Allergens – List allergens that are present in your food

-------

Details of provision of portable (drinking) water. -------

Details of hand washing facilities. (If handling open food, running hot and cold water, which should be easy to use, must be provided.) -------

List the hazards you have risk assessed for this operation -------

List the type and size of the fire safety equipment. -------

Operational Management Plan - if proposing mixed use, address how this will work operationally. -------

Address where things to be sold will be stored before they are offered for sale

-------

What type of receptical do you intend to use? please include detail of type and size of stall, please also describe stall layout -------

Please list all equipment to be used in the stall, including for the cooking / heating of food (if applicable), the storage/chilling/display of products, lighting and any ancillary equipment such as fire safety equipment, first aid facilities and portable water storage units / handwashing facilities (if applicable) -------

Please give the full address at which the receptacle will be stored outside trading hours

-------

Application Form

Add representation

Name:

Representee:

Is this an objection?

Comments: Characters remaining:

Document upload

Description

Conditions: View Conditions

Licence number

Licence type

Business Name

Address

Closing Date for Representations

Unique Access ID:

Submit Feedback

Name

Post Code

Contact details

Interested Party

Feedback type

Comment

Document upload

File format should be PDF, JPEG, or PNG Maximum file size is 11 MB
Description

Notification of Interest

Premises licence holder,
address and certificate number

Declarations

Data protection

Order summary

Application fee: £0.00

Declaration

IT IS AN OFFENCE, LIABLE ON CONVICTION TO A FINE UP TO LEVEL 5 ON THE STANDARD SCALE, UNDER SECTION 158 OF THE LICENSING ACT 2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS NOTIFICATION

Confirmation of the notifier or notifier's solicitor or other duly authorised agent. If signing on behalf of the notified please state in what capacity.

Sole Applicant - Individual or Other
Joint Applicant - Individual or Others

If signing/applying on behalf of the applicant, please state your name and in what capacity you are authorised to sign/apply. When submitting an online application form the 'Declaration made' checkbox must be selected.

Confirmation

Full Name

Date

Capacity

Applicant
Applicant's Solicitor
Authorised Agent

Declaration Made

Contact details

Contact details (where not previously given or where it differs from the notified)

Name

Address:

Telephone

Email address

Add Other Applicant

Individual Applicant

A person other than an individual - as a limited company/limited liability partners

A person other than an individual - as a partnership (other than limited liability)

A person other than an individual - as an unincorporated association

A person other than an individual - Other (for example a statutory corporation)

A Recognised Club

A Charity

The proprietor of an educational establishment

A health service body

As individual who is registered under Part 2 of the Care Standards Act 2000 (c14) in respect of an independent hospital in Wales

A person who is registered under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (within the meaning of that Part) in respect of an independent hospital in England

The chief officer of a police force in England and Wales

Name

Address

DOB

Nationality

Registered Number if Applicable

Description of applicant (for example partnership, company, unincorporated associations, etc)

Telephone

Email Address

Search address

Search results key

Residential address

Residential address on red route

Commercial address

Commercial address on red route

Address outside Westminster

Postcode lookup

Select address

My address is outside the UK

My address is not shown or has restrictions I disagree with

Outside address

Address line 1

Address line 2

Town/city

ZIP

Country

Licensable Activities

Hours for Licensable Activity

Licensable location (Indoors/Outdoors/Both)

Will the supply of alcohol be for consumption on premises or off premises or both? (please read guidance note 8)*

Location

Please provide further details (see guidance note 4)

State any seasonal variations (see guidance note 5)

Please state any non standard timings, where you intend to use the premises for the performance of plays at different times from the standard days and times listed (see guidance note 6)

View Conditions

Licence Condition

Type

Select a Condition

Condition Type

Completion Date

Description

Detail

Location(s)