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

Please Note:
This form is no longer live and can not be submitted

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

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