ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES
Licensing Act 2003
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Application to transfer premises licence to be granted under the Licensing Act 2003
Environmental Health
Isle of Wight Council
Jubilee Stores
The Quay
Newport
Isle of Wight
PO30 2EH
Before completing this form please click
here
to read the guidance notes.
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:
A Consent of Premises Licence Holder to Transfer form
should also be submitted in addition to this form.
A Designated Premises Supervisor (DPS) Consent
is also required but only if the DPS is changing.
*
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The Licence fee is not refundable should the application be withdrawn or refused.
Please tick this box to confirm you have read and accept these terms and conditions
The Licence fee of
will be required when submitting this application.
Your Details
*
Title
---
Mrs
Mr
Miss
Ms
Sir
Lord
Lady
Dr
Prof
Rev
Other
Other title
(please specify)
*
Forename
Middle name/Initials
*
Surname
*
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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