Please read the following enclosed documents when completing your application;
a) Guidance for Applicants
The completed form accompanied by the following should be sent to The Registration Office, Pontefract;
a) Fee £1600
b) Written consent of specified person(s) or Governing Authority(s)
OR
Confirmation that consent is not required
c) 2 copies of plans of premises; identifying layout of the premises for which you are seeking approval and identifying the room(s) in which civil partnerships will take place
d) Planning consent – confirming the premises may be used for civil partnerships
e) A list of names and addresses of all directors of the company - Where application is made by a
Company
The following documents must be made available at the request of the relevant responsible authority;
Building Control
- Fire Safety documentation
- Emergency Lighting documentation
- Staff training records
Type of Application (Grant or Renewal):
Approval expiry date: / Approval No:
FULL DETAILS OF APPLICANT
1. If applying as individual
Full Name:
Date of Birth:
Home Address:
Telephone No. / Mobile Telephone No.
E-mail address:
2. If applying as a limited company
Name of Company:
Address of Company:
(please give the address of the registered office and where different state the main trading address of the company):
Telephone No.
E-mail address:
Address for correspondence:
(Acting Agent or if different from applicants)
Name, telephone number and email of contact:
(for inspection purposes)
RESPONSIBLE PERSON
Full Name:
Occupation:
Telephone No. / Mobile Telephone No.
e-mail address:
DEPUTY TO RESPONSIBLE PERSON
Full Name:
Occupation:
Telephone No. / Mobile Telephone No.
e-mail address:
PREMISES TO BE APPROVED
Name of premises:
Address of premises:
Telephone No.
Denomination/nature of premises to be licensed (e.g. Parish Church, Synagogue):
Are the premises shared with other faith groups?
(If YES, please provide details)
Use of premises:
(Please provide details of the premises primary and other uses)
Are the premises fully accessible to wheelchair users?
Number of Rooms to be approved:
1. Name of Room (location)
Maximum No. of people:
2. Name of Room (location)
Maximum No. of people
3. Name of Room (location)
Maximum No. of people
CONSENT REQUIRED
I ……………………………………………….. Full Name: ………………………………………….
Trustee/Proprietor of this premises attach the written consent of .……………………………...
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
(name and address of person specified or governing authority)
Where the premises are shared with other faith groups or Churches
I ……………………………………………….. Full Name: ………………………………………….
Trustee/Proprietor of this premises attach the written consent of
1. …………………………………………………………………………………………………………
……………………………………………………………………………………………………………
(name and address of person specified or governing authority)
2. …………………………………………………………………………………………………………
……………………………………………………………………………………………………………
(name and address of person specified or governing authority)
3. …………………………………………………………………………………………………………
……………………………………………………………………………………………………………
(name and address of person specified or governing authority)
Attach additional sheets if necessary.
CONSENT NOT REQUIRED
I ……………………………………………….. Full Name: ………………………………………….
Trustee/Proprietor of this premises can confirm that no consent is required and that this information is true to the best of my knowledge and belief.
1. I have made application for the afore mentioned premises for which I am the trustee/proprietor, to be approved for the registration of civil partnerships.
2. I understand that;
a) the premises will be inspected for suitability before approval is granted and, if this
application is successful, may be subject to subsequent inspection;
b) public notice of the application will appear on the authority’s website for a period of 21
days andthat the authority may also decide to publish it in other ways if it considers it
necessary to do so.
c) approval, if granted, will be for a period of three years, and
d) the authority will need to be satisfied that appropriate health and safety provision and fire
safety is in place.
e) I have consulted with the planning authority as to whether planning consent is required
f) I attach written consent of the person specified /governing authority or
I can confirm that consent is not required and that this information is true to the best of my
knowledge and belief.
g) If the premises are shared with other faith groups or churches I attach written consent
from each person specified/each governing authority or
I can confirm that no consent is required and that this information is true to the best of my
knowledge and belief.
3. I confirm that I have read and understand the information contained in this application, the
guidance for applicants and the standard conditions.
4. I declare that if approved I will comply with the standard conditions and local conditions attached to the approval.
5. I confirm that I have enclosed the necessary documentation to proceed with the approval;
a) Fee
b) Written consent of specified person(s) or Governing Authority(s)
OR Confirmation that consent is not required
c) 2 copies of plans of premises; identifying layout of the premises for which you are seeking approval and identifying the room(s) in which civil partnerships will take place
d) Planning consent – confirming the premises may be used for civil partnerships
e) A list of names and addresses of all directors of the company - Where application is made by a
Company
Signed: ______
Interest in the Premises: ______
Date: ______
HEALTH & SAFETY ASSURANCE
Health and Safety Laws apply to all businesses. Under the provisions of the Health and Safety at Work etc. Act 1974, as an employer or self-employed person you are responsible for health and safety in your business. Health and Safety Laws are there to protect you, your employees and the public from workplace dangers.
As part of the application assessment process, please provide details of the following documents which you must have in place, as part of your safety management system.
Document/safety management system / Date of issue / Safety Issues identified
Yes/No / Remedial actions and/or annual review completed ( date)
Asbestos report and management plan?
Electrical Safety Certificate
Legionella Risk Assessment and management plan?
Gas Safety Certificate
Lift Safety Report (if applicable)
Public Liability Insurance
Declaration
I ______(name of applicant)
confirm that the above named documents have been issued and any remedial actions identified have been completed in respect of
______(name of venue)
and are a true reflection of the venue at the date of this application.
Signed:______
Dated: ______
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