Licensing Authority

Holbeach Office

9 Holbeach Road

London

SE6 4TW

020 8314 6400

ApplicationforaminorvariationtoapremiseslicenceorclubpremisescertificateundertheLicensingAct2003
PLEASEREADTHEFOLLOWINGINSTRUCTIONSFIRST
BeforecompletingthisformpleasereadtheGuidanceNotesattheendoftheform,especially
Note1.
Ifyouarecompletingthisformbyhandpleasewritelegiblyinblockcapitals. Inallcasesensurethatyouranswersareinsidetheboxesandinblackink.Useadditionalsheetsifnecessary.
Oncecompletedpleasesendyourapplicationtotherelevantlicensingauthority. Youmaywishtokeepacopyofthecompletedformforyourrecords.
(Insertname(s)ofapplicant)
beingthepremiseslicenceholder(s)/clubholdingaclubpremisescertificate,applytovaryapremiseslicenceundersection41A/clubpremisescertificateundersection86AoftheLicensingAct2003forthepremisesdescribedinPart1below.
Postaladdressofpremises(or,ifnone,ordnancesurveymapreference,ordescription)
Posttown / Postcode
Part1–Premisesdetails
Telephonenumberatpremises(ifany)
Premiseslicencenumber/clubpremisescertificatenumber
Briefdescriptionofpremises(PleaseseeGuidanceNote2)
Part2–ApplicantDetails
Iam/wearethepremiseslicenceholder/clubpremisescertificateholder.(Pleasedeleteasappropriate)
Contactphonenumberinworkinghours(ifany)
ApplicantPostaladdressIFDIFFERENTFROMPREMISESADDRESS
Posttown / Postcode
Pleaseprovideemailaddressifyouwouldpreferustocontactyoubyemail(optional)
Part3–Proposedvariation(s)
Pleasetick
Doyouwanttheproposedvariationtohaveeffectassoonaspossible?YesNo
Ifnot,fromwhatdatedoyouwantthevariationtotakeeffect?
DD / MM / YYYY
Pleasedescribetheproposedvariation(s)indetailintheboxbelowandexplainwhyyouconsiderthattheycouldnothaveanadverseeffectonthepromotionofanyofthelicensingobjectives(SeeGuidanceNote1).Thisshouldincludewhetherneworincreasedlevelsoflicensableactivitieswillbetakingplaceindoorsoroutdoors(indoorsmayincludeatent):
Detailsofproposedvariations(PleaseseeGuidanceNote3)
Detailsofproposedvariations(Continued)

Part4–OperatingSchedule

PleasetickthosepartsoftheOperatingSchedulewhichwouldbesubjecttochangeifthisapplicationtovarywassuccessful.

Provisionofregulatedentertainment

Pleasetickallthatapply

a.plays

b.films

c.indoorsportingevents

d.boxingorwrestlingentertainment

e.livemusic

f.recordedmusic

g.performancesofdance

h.anythingofasimilardescriptiontothatfallingwithin(e),(f)or(g)

Provisionoflatenightrefreshment

Salebyretailofalcohol

(Notethatthiscanonlyrelatetoreducinglicensedhoursormovingthemwithoutanyoverallincreasebetween7amand11pm)

Pleaseticktoindicateyouhaveenclosedthefollowing:

Ihaveenclosedthepremiseslicence/clubpremisescertificate

Ihaveenclosedtherelevantpartofthepremiseslicence/

clubpremisescertificate

Ihaveincludedacopyoftheplan

(necessaryiftheproposedvariationwillaffectthelayout)

Ifyouhavenottickedoneofthepreviousthreeboxes,pleaseexplainwhyintheboxbelow.

Reasonswhyyouhavenotenclosedthepremiseslicence/clubpremisescertificateorrelevantparts.
Anyfurtherinformationtosupportyourapplication.(SeeGuidanceNote4)

CHECKLIST:

Pleaseticktoindicateagreement

  • Ihavemadeorenclosedpaymentofthefee.
  • Ihaveenclosedtheplan,ifappropriate,ofthepremisesinscale[1mmto100mm],unlessotherwiseagreedwiththelicensingauthority.
  • Ihaveenclosedthepremiseslicence/clubpremisescertificateorrelevantpartofitorprovidedanexplanation.
  • IunderstandthatifIdonotcomplywiththeaboverequirementsmyapplicationwillberejected.
  • IunderstandthatIamrequiredtoadvertisemyapplicationbypostingawhitenoticeatoronthepremisesfortenconsecutivedayscommencingon,andincludingthe dayafterthedaywhenmyapplicationisgiventothelicensingauthority.

ITISANOFFENCE,LIABLEONSUMMARYCONVICTIONTOAFINENOTEXCEEDINGLEVEL5ONTHESTANDARDSCALE,UNDERSECTION158OFTHELICENSINGACT2003,TOMAKEAFALSESTATEMENTINORINCONNECTIONWITHTHISAPPLICATION.

Part5–SignaturesandContactDetails

(SeeGuidanceNote5)

PremisesLicence:Signatureofapplicant(thecurrentpremiseslicenceholder)orapplicant’ssolicitororotherdulyauthorisedagent(seeGuidanceNote6).Ifsigningonbehalfoftheapplicant,pleasestateyournameandinwhatcapacityyouareauthorisedtosign:

Signature:

Date:

Capacity:I/We(insertfullnameandcapacity)

signonbehalfofandhaveauthoritytobindtheapplicant.

Wherethepremiseslicenceisjointlyheld,signatureof2ndapplicant(thecurrentpremiseslicenceholder)or2ndapplicant’ssolicitororotherauthorisedagent(SeeGuidanceNote7).Ifsigningonbehalfoftheapplicant,pleasestateinwhatcapacity.

Signature:

Date:

Capacity:I/We(insertfullnameandcapacity)

signonbehalfofandhaveauthoritytobindtheapplicant.

Wherethepremisesisaclub

I(insertfullname) makethisapplicationonbehalfoftheclubandhaveauthoritytobindtheclub.

Signature:

Date:

Capacity:I/We(insertfullnameandcapacity)

signonbehalfofandhaveauthoritytobindtheapplicant.

Contactname(wherenotpreviouslygiven)andaddressforcorrespondenceassociatedwiththisapplication.(SeeGuidanceNote8)
Posttown / Postcode
Telephonenumber(ifany) / Ifyouwouldpreferustocorrespondwithyoubyemailyouremailaddress(optional)

NotesforGuidance

1.GeneralNote: Theminorvariationsprocesscanonlybeusedforvariationsthatcouldhavenoadverseimpactonthepromotionofanyofthefourlicensingobjectives.(Theseare:thepreventionofcrimeanddisorder;publicsafety;thepreventionofpublicnuisance;andtheprotectionofchildrenfromharm.)

Itcannotbeusedto:

  • extendtheperiodforwhichthelicencehaseffect;
  • varysubstantiallythepremisestowhichitrelates;
  • specify,inapremiseslicence,anindividualasthedesignated premisessupervisor;
  • addthesalebyretailorsupplyofalcoholasanactivityauthorisedbyalicenceorcertificate;
  • authorisethesalebyretailorsupplyofalcoholatanytimebetween11pmand7am;
  • authoriseanincreaseintheamountoftimeonanydayduringwhichalcoholmaybesoldbyretailorsupplied;
  • includethealternativelicenceconditionreferredtoinsection41D(3)oftheLicensingAct2003inapremiseslicence.

2.Descriptionofpremises:Forexamplethetypeofpremises,itsgeneralsituationandlayoutandanyotherinformationwhichcouldberelevanttothelicensingobjectives.Thisshouldincludeanyactivitiesinorassociatedwiththeuseofthepremiseswhichmaygiverisetoconcerninrespectofchildrenregardlessofwhetheryouintendchildrentohaveaccesstothepremises,forexample(butnotexclusively)nudityorsemi-nudity,filmsforrestrictedagegroups,thepresenceofgamingmachinesetc.

3.Givefulldetailsofalltheproposedvariation(s).Failuretoprovidesufficientinformationmayleadtotherefusalofyourapplication.Detailsshouldincludeadescriptionoftheproposedvariation(s)intermsaspreciseaspossible.Ifyouarenotprecise,thelicensingauthoritymaydecidethatthechangesyouproposewouldbepotentiallybroaderinscopethanyouintendandrejectyourapplicationasnotbeinga‘minor’variation.Youshouldalsoincludeastatementaboutwhyyouconsiderthevariationsproposedcouldnothaveanimpactonthelicensingobjectiveslistedinsection4(2)oftheAct.Youshouldcovereachoftheobjectivesthatcouldpossiblyapplytoyourproposal(orifmorethanone,toeachproposal)andsaywhyyouthinktherecouldbenoadverseimpactonthatobjective.Yourapplicationwillbeassistedbyincludingasmuchinformationasyoucanaboutthis.(However,thereisaboxattheendoftheformfor‘furtherinformation’,andthisshouldbeusedforanyrelevantbackgroundinformationnotdirectlyrelatedtothevariation.)Relevantinformationincludes:

a)Variationstolicensableactivities/licensinghours(alltimingsshouldbegivenin24hourclocke.g.16.00.Onlygivedetailsforthedaysoftheweekwhenyouintendthepremisestobeusedfortheactivity),suchas:

  • Whetherneworincreasedlevelsoflicensableactivitieswillbetakingplaceindoorsoroutdoors(indoorsmayincludeatent);
  • Relevantfurtherdetails,forexamplewhethermusicwillbeamplifiedorunamplified;
  • Standarddaysandtimingwhentheactivitywilltakeplace,includingstartandfinishtimes;
  • Anyseasonalvariationsintimings,e.g.additionaldaysduringthesummer;and
  • Non-standardtimings,e.g.whereyouwishtheactivitytogoonlongeronaparticulardaysuchasChristmasEve.

b)Variationstopremises/clublayout:Ifyouareapplyingforavariationtothelayoutofyourpremises,youmustincludearevisedplan.Youshouldbeawarethatyourapplicationislikelytoberefusediftheproposedvariationcould:

  • increasecapacityfordrinkingonthepremises;
  • affectaccessbetweenthepublicpartofthepremisesandtherestofthepremisesorthestreetorpublicway,e.g.blockemergencyexitsorroutestoemergencyexits;or
  • impedetheeffectiveoperationofanoisereductionmeasure.

c)Revisions,removalsandadditionsofconditions:Theminorvariationprocessmaybeusedtoremoveconditionswhichareoutofdateorinvalidandtoreviseconditionswhichareunclear(aslongastheintentionandeffectremainsthesame).Itcanalsobeusedtoaddanewconditionvolunteeredbytheapplicantormutuallyagreedbetweentheapplicantandaresponsibleauthority,suchasthepoliceortheenvironmentalhealthauthority(subjecttoimpactonthelicensingobjectives).

d)Variationstoopeninghours:Detailsofanychangestohourswhenthepremisesorclubisopentothepublic.

4.Furtherinformation:Youshouldusethisboxtoprovideanyadditionalevidencetosupportyourclaimthattheproposedvariationis‘minor’andcouldnothaveanadverseimpactonthepromotionofthelicensingobjectives.

5.Signatures:Theapplicationformmustbesigned.

6.Authorisedagent:Anapplicant’sagent(e.g.solicitor)maysigntheformontheirbehalfand,insodoing,willbeconfirmingthattheyhaveactualauthoritytodoso.

7.2ndApplicant:Wherethereismorethanoneapplicant,bothapplicantsortheirrespectiveagentsmustsigntheapplicationform.

8.Thisistheaddresswhichweshallusetocorrespondwithyouaboutthisapplication.Thismightnotbethesameastheaddressofthepremisesorapplicant,buttheseaddressesmustalsobeprovided.

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