WEST DUNBARTONSHIRE LICENSING BOARD LICENSING (SCOTLAND) ACT 2005 APPLICATION

TO WEST DUNBARTONSHIRE COUNCIL PERMISSION REQUEST APPLICATION FOR
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WEST DUNBARTONSHIRE LICENSING BOARD LICENSING (SCOTLAND) ACT 2005 APPLICATION
WEST DUNBARTONSHIRE LICENSING BOARD LICENSING (SCOTLAND) ACT 2005 SECTION

West Dunbartonshire Licensing Board

WEST DUNBARTONSHIRE LICENSING BOARD


LICENSING (SCOTLAND) ACT 2005


APPLICATION FOR VARIATION OF PREMISES LICENCE

TO INTIMATE A PREMISES MANAGER


This application form is only to be used to intimate a Premises Manager – no other aspect of the Premises Licence can be varied using this form.


Please complete all sections of the application form.



SECTION 1: DETAILS OF PREMISES LICENCE


1(a) Reference Number of Premises Licence

     


1(b) Name and Address of Premises


     

Post Code

     

Telephone No.

     



SECTION 2: DETAILS OF PREMISES MANAGER (See Note 1 below)


2(a) Name, Address and Telephone No. of Premises Manager


     

Post Code

     

Telephone No.

     


2(b) Date of Birth of Premises Manager

     


2(c) Email Address of Premises Manager

     


2(d) Details of Personal Licence held by Premises Manager

Date of Issue

Name of Licensing Board issuing

Reference Number of

Personal Licence

     

     

     


(Please enclose a photostat copy of the Personal Licence if it was not issued by West Dunbartonshire Licensing Board.)





SECTION 3: LICENCE TO BE AMENDED (See Note 2 below)


Does the relevant Premises Licence accompany this application? YES NO


(If the answer is NO, please provide an explanation.)


I am unable to produce the Premises Licence because:


The licence has not yet been issued by the Board


The licence has already been returned to the Board in respect of an earlier application for variation or transfer


Other (provide details)      ………………………………………………….……

……………………………………………………………………………………………

……………………………………………………………………………………………



DECLARATION BY APPLICANT OR AGENT ON BEHALF OF APPLICANT


(If signing on behalf of the applicant please state in what capacity.)


I confirm that the contents of this application are true to the best of my knowledge and belief.


The application fee of £31 is enclosed.


A copy of the proposed Premises Manager’s Personal Licence is enclosed YES NO



Signature ………………………………………………………..…………. (See Note 3 below)


Date      ……………………………………………….


Capacity APPLICANT/AGENT (delete as appropriate)


If agent, please provide name, address, telephone number and email address:


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Notes

Note 1:


The holder of a Personal Licence may only be named as the Premises Manager of one premises in Scotland at any time (subject to Article 4 of the Licensing (Vessels etc.) (Scotland) Regulations 2007).


Note 2:


The relevant Premises Licence (including the Summary of the Premises Licence) must be returned to the Licensing Authority in order that the licence documents can be updated to reflect the details of the nominated Premises Manager.


Note 3:


Data Protection Act 1998

The information in this form will be used to update the relevant Premises Licence. Accordingly, the information contained in this form may be held on an electronic public register which may be available to members of the public on request.





Contact Us:


West Dunbartonshire Licensing Board

Council Offices

16 Church Street

Dumbarton

G82 1QL

Phone: 01389 738741

Email: [email protected]






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