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Application for a Premises Licence to be Granted Under
the Licensing Act 2003

Please Note:
This form can be submitted online with a card payment
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Application for a premises licence to be granted under the Licensing Act 2003
Before completing this form please click here to read the guidance notes.

Please Note: A Consent of Premises Licence Holder to Transfer form must also be submitted in addition to this form.
* Please click here to view the fee structure under the Licensing Act 2003.

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

The giving of false information may result in registration being refused or revoked, and the local authority reserve the right to make such further enquiries arising out of this application as they may consider desirable.

The Licence fee is not refundable should the application be withdrawn or refused.

 
*  



A) A) For premises with no rateable value to £4,300
B) B) For premises with rateable value from £4,301 to £33,000
C) C) For premises with a rateable value of £33,001 to £87,000
D) D) For premises with a rateable value from £87,001 to £125,000
E) E) For premises with a rateable value of £125,001 and above
Your Details
* Title Other title
(please specify)
* Forename
Middle name/Initials
* Surname
* Building/house name/number
 
* Street address
 
* Town name
 
* County  
* Postcode
 
*  Tel number
(include area code)
 
* Email address         
Fax

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