IWC eForms
ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES
Licensing Act 2003

Please Note:
This form can be submitted online
YOU MUST BE LOGGED IN TO SAVE AND SUBMIT THIS FORM
You are not currently logged in to My Account, however you may
IWCComplete the form and obtain a printout at the end
If you log in you may
IWCPre-populate certain details from your Account
Save your form at any time and complete it later
IWCSubmit your form online.

Declaration for a club premises certificate to be granted under the Licensing Act 2003
Environmental Health
Isle of Wight Council
Jubilee Stores
The Quay
Newport
Isle of Wight
PO30 2EH
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.

Please note: An Application for a Club Premises Certificate must also be submitted along with this form.
Your Details
* Forename
Middle name/Initials
* Surname
 
* Building/house name/number
 
* Street address
 
* Town name
 
* County
 
* Postcode
 
*  Tel number
(include area code)

 
* Email address
 
 
Fax

Close Window