Isle of Wight Council

	Application for Grant/ Renewal/ Transfer/ Variation of Licence for a Sex Establishment
	Please click here for a Notice of Application and here for a Certificate of Publication of Notice of Application.
*	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. This application fee is not refundable in the event of the application being refused or otherwise. I declare that I have completed a Notice of Application for a Licence, one copy of which is displayed at the premises for 28 days, the other copy which is displayed at the premises which has been sent to the County Press. I understand that I will also need to complete a 'Certificate of Publication of Notice of Application for a Licence' and return it to the Licencing Authority following the expiry of the notice period. Please tick this box to confirm you have read and accept the terms and conditions
	Applicants Details
	The Licence fee of £3,500.00 will be required when submitting this application

*	Is the application on behalf of an individual or a corporate or unincorporated body? individual corporate body unincorporated body
	If individual, please provide:

	Title
	Forename
	Middle name/Initials
	Surname

	Building/house name/number
	Street address
	Town name
	County
	Postcode
	Tel number (include area code)
	Email address
	Fax
	Age
	Date of birth	Year Month Day

	Place of birth
	Have you been resident in the United Kingdom throughout a period of six months immediately preceding the date of this application?	Yes No
	Have you ever been refused a licence for a sex establishment?	Yes No
	If yes, please give details

If application is made on behalf of a corporate or unincorporated body please provide the name of the body and the address of registered or principal office:

	Name of body
	Building name/number
	Street address
	Town name
	County
	Postcode
	Telephone number (include area code)
	Email address
	Fax
	If the application is made on behalf of a body corporate, is that body incorporated in the United Kingdom?	Yes No

	Management Details
	Give full names and private, permanent addresses of all directors or other persons responsible for management of the establishment:
	Person 1

*	Title
*	Forename
	Middle name/Initials
*	Surname

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

Person 2

	Title
	Forename
	Middle name/Initials
	Surname

	Building/house name/number
	Street address
	Town name
	County
	Postcode
	Telephone number (include area code)
	Email address
	Continue here if more than 2 persons

	Convictions
	Notes: All convictions must be disclosed. Spent convictions, as defined here , should not be included. A sentence of more than 2 and a half years imprisonment can never become spent.

Have you any convictions recorded against you? Or, if a body corporate or unincorporated body, that body or any of its directors or other persons responsible for its management? If so, please state (if for renewal, since you last applied for a licence):

	Date of Conviction	Offence	Sentence (including suspended sentence)

Premises Details

*	Building name/number
*	Street address
*	Town name
*	County
*	Postcode
	Does this application relate to a vehicle to a vehicle/vessel/stall?	Yes No
	If 'yes,' please give description and state where it is to be used as a sex establishment

Trading Details

*	During which hours do you wish to trade?
*	On which dates do you wish to trade?
*	Are the premises to be used as a sex shop?	Yes No
*	Are the premises to be used as a sex cinema?	Yes No
*	Are the premises to be used as sex encounter establishment?	Yes No

	Declaration
	I declare that I have checked the information given on this application form and to the best of my knowledge and belief it is correct. I understand that a false or misleading statement, or that withholding relevant information, may result in the refusal or revocation of the licence and\or may render me liable to prosecution. Signed............................................................... Name................................................................ Date..................................................................
	This form must be signed and all the relevant documents, detailed on the form, presented to the licensing section before a decision is made and the licence may be granted. Either print off the completed form, sign and post to the licensing department along with the required documents or attend council offices after you have submitted the form online. The application fee is not refundable in the event of the application being refused or otherwise.

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box