DPS Consent Form

ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES

DPS Consent Form

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	DPS Consent Form
	Environmental Health Isle of Wight Council Jubilee Stores The Quay Newport Isle of Wight PO30 2EH
	Please Note: This form should accompany an Application to Vary a Premises Licence or an Application to Transfer a Premises Licence
	Consent of individual to being specified as premises supervisor under Licensing Act 2003.

Application Details

*	Name of Applicant
*	Type of Application (Please state either VARIATION or TRANSFER)

Individual details of person being specified as premises supervisor

Title

other title
(please specify)

*	Building/house name/number
*	Street
*	Town
*	County
*	Postcode
*	Telephone number (include area code)
*	Email address
	Fax

Fields marked '*' are required entries.

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