Isle of Wight Council

NOTICE OF APPLICATION FOR A LICENCE Licensing of Sex Establishments

Applicant Details

*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street
*	Town
	County
*	Postcode
	Contact telephone number
	Email address

Premises Details

*	Business name
*	Building name/number
*	Street
*	Town
	County
*	Postcode
	Telephone number
	Email address

	Declaration
	I\we hereby give notice that I/we have applied to the ISLE OF WIGHT COUNCIL under the provisions of the Local Government (Miscellaneous Provisions) Act 1982 for a licence to use the premises referred to above as a [sex shop][sex cinema][sex encounter establishment].** . Any person wishing to make representations about the application should make them in writing to the SENIOR LICENSING OFFICER, Environmental Health Department, Jubilee Stores, The Quay, Newport, Isle of Wight PO30 2EH within 28 days of the date of this notice. Signed ............................................................................... Name................................................................................. On behalf of....................................................................... Date (a).............................................................................. **Delete where appropriate (a) The date to be inserted shall be the date on which application is made to the Council.
	This form must be signed and 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 or attend council offices to sign after you have submitted the form online.

	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

Date printed: 07/03/2013