Application for the review of a premises licence under the Licensing Act 2003

All fields marked with a * are required entries

Licensing Act 2003

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	Application for the review of a premises licence under the Licensing Act 2003
	Environmental Health Isle of Wight Council Jubilee Stores The Quay Newport Isle of Wight PO30 2EH

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I/We (Insert name of applicant) apply for the review of a premises licence under section 51 of the of the Licensing Act 2003 for the premises described in Part 1.

Part 1 - Premises Details

Premises licence number
(if known)

	Building name/number
	Street
	Town
	County
	Postcode
	If no postal address please provide ordnance survey map reference
	Name of premises licence holder (if known)

Fields marked '*' are required entries.

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