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Application to vary a club premises certificate to be granted under the Licensing Act 2003

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Application to vary 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
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.
* The giving of false information may result in the certificate 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The fee is not refundable should the application be withdrawn or refused.
 
*  



A) A) For premises with no rateable value to £4,300
B) B) For premises with rateable value from £4,301 to £33,000
C) C) For premises with a rateable value of £33,001 to £87,000
D) D) For premises with a rateable value from £87,001 to £125,000
E) E) For premises with a rateable value of £125,001 and above
Your Details
* Title Other title
(please specify)
* Forename
 
Middle name/Initials
* Surname
 
* Building/house name/number
 
* Street address
 
* Town name
 
* County

 

* Postcode
 
*  Telephone number
(include area code)
 
* Email address

 
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