Application for a provisional statement to be granted

undertheLicensingAct2003

PLEASEREADTHEFOLLOWINGINSTRUCTIONSFIRST

Beforecompletingthisformpleasereadtheguidancenotesattheendoftheform. Ifyouarecompletingthisformbyhandpleasewritelegiblyinblockcapitals. Inallcasesensurethatyouranswersareinsidetheboxesandwritteninblackink. Useadditionalsheetsifnecessary.

Youmaywishtokeepacopyofthecompletedformforyourrecords.

I/We

(Insertname(s)ofapplicant)

applyforaprovisionalstatementundersection29oftheLicensingAct2003forthepremisesdescribedinPart1below(thepremises)andI/wearemakingthisapplicationtoyouastherelevantlicensingauthorityinaccordancewithsection12oftheLicensingAct2003

Part1–PremisesDetails

Postaladdressofpremisesor,ifnone,ordnancesurveymapreferenceordescription
Posttown / Postcode
Telephonenumberatpremises(ifany)
Non-domesticrateablevalueofpremises / £

Part2-ApplicantDetails

PleasestatewhetheryouareapplyingforapremiseslicenceasPleasetickallthatapply

a) / anindividualorindividuals* / pleasecompletesection(A)
b) / apersonotherthananindividual*
i / asalimitedcompany/limited liability partnership / pleasecompletesection(B)
ii / asapartnership (other than limited liability) / pleasecompletesection(B)
iii / asanunincorporatedassociationor / pleasecompletesection(B)
iv / other(forexampleastatutorycorporation) / pleasecompletesection(B)
c) / arecognisedclub / pleasecompletesection(B)
d) / acharity / pleasecompletesection(B)
e) / theproprietorofaneducationalestablishment / pleasecompletesection(B)
f) / ahealthservicebody / pleasecompletesection(B)
g)
ga) / apersonwhoisregisteredunderPart2oftheCareStandardsAct2000(c14)inrespectofanindependenthospitalinWales
apersonwhoisregisteredunderChapter2ofPart1oftheHealthandSocialCareAct2008(withinthemeaningofthatPart)inanindependenthospitalinEngland / pleasecompletesection(B)
pleasecompletesection(B)
h) / thechiefofficerofpoliceofapoliceforceinEnglandandWales / pleasecompletesection(B)
*Ifyouareapplyingasapersondescribedin(a)or(b)pleaseconfirm (by ticking one box below):
  • Iamcarryingonorproposingtocarryonabusinesswhichinvolvestheuseofthepremisesforlicensableactivities;or

  • Iammakingtheapplicationpursuanttoa

  • statutoryfunctionor

  • afunctiondischargedbyvirtueofHerMajesty’sprerogative

(A)INDIVIDUALAPPLICANTS(fillinasapplicable)

Mr
/ Mrs
/ Miss
/ Ms
/ OtherTitle(forexample,Rev) /
Surname / Firstnames
Iam18yearsoldorover / Pleasetickyes
Currentpostaladdressifdifferentfrompremisesaddress
Posttown / Postcode
Daytimecontacttelephonenumber
E-mailaddress(optional)

SECONDINDIVIDUALAPPLICANT(ifapplicable)

Mr
/ Mrs
/ Miss
/ Ms
/ OtherTitle(forexample,Rev) /
Surname / Firstnames
Iam18yearsoldorover / Pleasetickyes
Currentpostaladdressifdifferentfrompremisesaddress
Posttown / Postcode
Daytimecontacttelephonenumber
E-mailaddress(optional)

(B)OTHERAPPLICANTS

Pleaseprovidenameandregisteredaddressofapplicantinfull.Whereappropriatepleasegiveanyregisterednumber.Inthecaseofapartnershiporotherjointventure(otherthanabodycorporate),pleasegivethenameandaddressofeachpartyconcerned

Name
Address
Registerednumber(whereapplicable)
Descriptionofapplicant(forexample,partnership,company,unincorporatedassociation)
Telephonenumber(ifany)
E-mailaddress(optional)

Whatisthenatureofyourinterestinthepremises?

Part3–Scheduleofworks

Isthepremises / Pleasetickasappropriate
abouttobeconstructed
beingextendedoraltered
Pleasegivedetailsoftheworkandpleaseattachplansoftheworkbeingdoneorabouttobedoneatthepremises
Pleasegiveparticularsofthepremisestowhichtheapplicationrelates(pleasereadguidancenote1)

Whichlicensableactivitieswillthepremisesbeusedfor?

Provisionofregulatedentertainment (please read guidance note 2) / Pleasetickall that apply
a) / plays(optional,fillinboxA)
b) / films(optional,fillinboxB)
c) / indoorsportingevents(optional,fillinboxC)
d) / boxingorwrestlingentertainment(optional,fillinboxD)
e) / livemusic(optional,fillinboxE)
f) / recordedmusic(optional,fillinboxF)
g) / performancesofdance(optional,fillinboxG)
h) / anythingofasimilardescriptiontothatfallingwithin(e),(f)or(g)(optional,fillinboxH)
Provisionoflatenightrefreshment(optional,fillinboxI)
Supplyofalcohol(optional,fillinboxJ)

CompleteboxesK,LandM(optional)

Part4–OPTIONAL–youmayfillinthissectionifyouchooseto

Generaldescriptionofpremises(pleasereadguidancenote1)

A

Plays
Standarddaysandtimings(pleasereadguidancenote7) / Willtheperformanceofaplaytakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Tue
Wed / Stateanyseasonalvariationsforperformingplays(pleasereadguidancenote5)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheperformanceofplaysatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sat
Sun

B

Films
Standarddaysandtimings(pleasereadguidancenote7) / Willtheexhibitionoffilmstakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Tue
Wed / Stateanyseasonalvariationsfortheexhibitionoffilms(pleasereadguidancenote5)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheexhibitionoffilmsatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sat
Sun

C

Indoorsportingevents
Standarddaysandtimings(pleasereadguidancenote7) / Pleasegivefurtherdetails(pleasereadguidancenote4)
Day / Start / Finish
Mon
Tue / Stateanyseasonalvariationsforindoorsportingevents(pleasereadguidancenote5)
Wed
Thur / Nonstandardtimings. Whereyouintendtousethepremisesforindoorsportingeventsatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Fri
Sat
Sun

D

Boxingorwrestlingentertainments
Standarddaysandtimings(pleasereadguidancenote7) / Willtheboxingorwrestlingentertainmenttakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Tue
Wed / Stateanyseasonalvariationsforboxingorwrestlingentertainment(pleasereadguidancenote5)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesforboxingorwrestlingentertainmentatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sat
Sun

E

Livemusic
Standarddaysandtimings(pleasereadguidancenote7) / Willtheperformanceoflivemusictakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Tue
Wed / Stateanyseasonalvariationsfortheperformanceoflivemusic(pleasereadguidancenote5)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheperformanceoflivemusicatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sat
Sun

F

Recordedmusic
Standarddaysandtimings(pleasereadguidancenote7) / Willtheplayingofrecordedmusictakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Tue
Wed / Stateanyseasonalvariationsfortheplayingofrecordedmusic(pleasereadguidancenote5)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheplayingofrecordedmusicatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sat
Sun

G

Performancesofdance
Standarddaysandtimings(pleasereadguidancenote7) / Willtheperformanceofdancetakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Tue
Wed / Stateanyseasonalvariationsfortheperformanceofdance(pleasereadguidancenote5)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheperformanceofdanceatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sat
Sun

H

Anythingofasimilardescriptiontothatfallingwithin(e),(f)or(g)
Standarddaysandtimings(pleasereadguidancenote7) / Pleasegiveadescriptionofthetypeofentertainmentyouwillbeproviding
Day / Start / Finish / Willthisentertainmenttakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Mon / Outdoors
Both
Tue / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Wed
Thur / Stateanyseasonalvariationsforentertainmentofasimilardescriptiontothatfallingwithin(e),(f)or(g) (pleasereadguidancenote5)
Fri
Sat / Nonstandardtimings. Whereyouintendtousethepremisesfortheentertainmentofasimilardescriptiontothatfallingwithin(e),(f)or(g)atdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sun

I

Latenightrefreshment
Standarddaysandtimings(pleasereadguidancenote7) / Willtheprovisionoflatenightrefreshmenttakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote3) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote4)
Tue
Wed / Stateanyseasonalvariationsfortheprovisionoflatenightrefreshment(pleasereadguidancenote5)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheprovisionoflatenightrefreshmentatdifferenttimes,tothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Sat
Sun

J

Supplyofalcohol
Standarddaysandtimings(pleasereadguidancenote7) / Willthesupplyofalcoholbeforconsumption–pleasetick(pleasereadguidancenote8) / Onthepremises
Offthepremises
Day / Start / Finish / Both
Mon / Stateanyseasonalvariationsforthesupplyofalcohol(pleasereadguidancenote5)
Tue
Wed
Thur / Nonstandardtimings. Whereyouintendtousethepremisesforthesupplyofalcoholatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Fri
Sat
Sun

K

Pleasehighlightanyadultentertainmentorservices,activities,otherentertainmentormattersancillarytotheuseofthepremisesthatmaygiverisetoconcerninrespectofchildren(pleasereadguidancenote9).

L

Hourspremisesareopentothepublic
Standardtimings(pleasereadguidancenote7) / Stateanyseasonalvariations(pleasereadguidancenote5)
Day / Start / Finish
Mon
Tue
Wed
Nonstandardtimings. Whereyouintendthepremisestobeopentothepublicatdifferenttimesfromthoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote6)
Thur
Fri
Sat
Sun

MDescribethestepsyouintendtotaketopromotethefourlicensingobjectives:

a)General–allfourlicensingobjectives(b,c,dande)(pleasereadguidancenote10)

b)Thepreventionofcrimeanddisorder

c)Publicsafety

d)Thepreventionofpublicnuisance

e)Theprotectionofchildrenfromharm

Checklist:

Pleaseticktoindicateagreement
/ Ihavemadeorenclosedpaymentofthefee.
/ Ihaveenclosedtheplansoftheworkstobedoneatthepremises.
/ Ihavesentcopiesofthisapplicationandtheplantoresponsibleauthoritiesandotherswhereapplicable.
/ IunderstandthatImustnowadvertisemyapplication.
/ IunderstandthatifIdonotcomplywiththeaboverequirementsmyapplicationwillberejected.

IT IS AN OFFENCE, UNDER SECTION 158 OF THE LICENSING ACT 2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION. THOSE WHO MAKE A FALSE STATEMENT MAY BE LIABLE ON SUMMARY CONVICTION TO A FINE OF ANY AMOUNT.

Part5–Signatures (pleasereadguidancenote11)

Signatureofapplicantorapplicant’ssolicitororotherdulyauthorisedagent(seeguidancenote12). Ifsigningonbehalfoftheapplicant,pleasestateinwhatcapacity.

Signature
Date
Capacity

Forjointapplications,signatureof2ndapplicantor2ndapplicant’ssolicitororotherauthorisedagent(pleasereadguidancenote13). Ifsigningonbehalfoftheapplicant,pleasestateinwhatcapacity.

Signature
Date
Capacity
Contactname(wherenotpreviouslygiven)andpostaladdressforcorrespondenceassociatedwiththisapplication(pleasereadguidancenote14).
Posttown / Postcode
Telephonenumber(ifany)
Ifyouwouldpreferustocorrespondwithyoubye-mail,youre-mailaddress(optional).

NotesforGuidance

  1. Describethepremises,forexamplethetypeofpremises,theirgeneralsituationandlayoutandanyotherinformationwhichcouldberelevanttothelicensingobjectives.WhereyouarecompletingPart4andyourapplicationincludesoff-suppliesofalcoholandyouintendtoprovideaplaceforconsumptionoftheseoff-supplies,youmustincludeadescriptionofwheretheplacewillbeanditsproximitytothepremises.
  2. In terms of specific regulated entertainments please note that:
  • Plays: no licence is required for performances between 08.00 and 23.00 on any day, provided that the audience does not exceed 500.
  • Films: no licence is required for ‘not-for-profit’ film exhibition held in community premises between 08.00 and 23.00 on any day provided that the audience does not exceed 500 and the organiser (a) gets consent to the screening from a person who is responsible for the premises; and (b) ensures that each such screening abides by age classification ratings.
  • Indoor sporting events: no licence is required for performances between 08.00 and 23.00 on any day, provided that the audience does not exceed 1000.
  • Boxing or Wrestling Entertainment: no licence is required for a contest, exhibition or display of Greco-Roman wrestling, or freestyle wrestling between 08.00 and 23.00 on any day, provided that the audience does not exceed 1000. Combined fighting sports – defined as a contest, exhibition or display which combines boxing or wrestling with one or more martial arts – are licensable as a boxing or wrestling entertainment rather than an indoor sporting event.
  • Live music: no licence permission is required for:
  • a performance of unamplified live music between 08.00 and 23.00 on any day, on any premises.
  • a performance of amplified live music between 08.00 and 23.00 on any day on premises authorised to sell alcohol for consumption on those premises, provided that the audience does not exceed 500.
  • a performance of amplified live music between 08.00 and 23.00 on any day, in a workplace that is not licensed to sell alcohol on those premises, provided that the audience does not exceed 500.
  • a performance of amplified live music between 08.00 and 23.00 on any day, in a church hall, village hall, community hall, or other similar community premises, that is not licensed by a premises licence to sell alcohol, provided that (a) the audience does not exceed 500, and (b) the organiser gets consent for the performance from a person who is responsible for the premises.
  • a performance of amplified live music between 08.00 and 23.00 on any day, at the non-residential premises of (i) a local authority, or (ii) a school, or (iii) a hospital, provided that (a) the audience does not exceed 500, and (b) the organiser gets consent for the performance on the relevant premises from: (i) the local authority concerned, or (ii) the school or (iii) the health care provider for the hospital.
  • Recorded Music: no licence permission is required for:
  • any playing of recorded music between 08.00 and 23.00 on any day on premises authorised to sell alcohol for consumption on those premises, provided that the audience does not exceed 500.
  • any playing of recorded music between 08.00 and 23.00 on any day, in a church hall, village hall, community hall, or other similar community premises, that is not licensed by a premises licence to sell alcohol, provided that (a) the audience does not exceed 500, and (b) the organiser gets consent for the performance from a person who is responsible for the premises.
  • any playing of recorded music between 08.00 and 23.00 on any day, at the non-residential premises of (i) a local authority, or (ii) a school, or (iii) a hospital, provided that (a) the audience does not exceed 500, and (b) the organiser gets consent for the performance on the relevant premises from: (i) the local authority concerned, or (ii)the school proprietor or (iii) the health care provider for the hospital.
  • Dance: no licence is required for performances between 08.00 and 23.00 on any day, provided that the audience does not exceed 500. However, a performance which amounts to adult entertainment remains licensable.
  • Cross activity exemptions: no licence is required between 08.00 and 23.00 on any day, with no limit on audience size for:
  • any entertainment taking place on the premises of the local authority where the entertainment is provided by or on behalf of the local authority;
  • any entertainment taking place on the hospital premises of the health care provider where the entertainment is provided by or on behalf of the health care provider;
  • any entertainment taking place on the premises of the school where the entertainment is provided by or on behalf of the school proprietor;and
  • any entertainment (excluding films and a boxing or wrestling entertainment) taking place at a travelling circus, provided that (a) it takes place within a moveable structure that accommodates the audience, and (b) that the travelling circus has not been located on the same site for more than 28 consecutive days.
  1. Wheretakingplaceinabuildingorotherstructurepleasetickasappropriate(indoorsmayincludeatent).
  2. Forexamplethetypeofactivitytobeauthorised,ifnotalreadystated,andgiverelevantfurtherdetails,forexample(butnotexclusively)whetherornotmusicwillbeamplifiedorunamplified.
  3. Forexample(butnotexclusively),wheretheactivitywilloccuronadditionaldaysduringthesummermonths.
  4. Forexample(butnotexclusively),whereyouwishtheactivitytogoonlongeronaparticulardaye.g.ChristmasEve.
  5. Pleasegivetimingsin24hourclock(e.g.16.00)andonlygivedetailsforthedaysoftheweekwhenyouintendthepremisestobeusedfortheactivity.
  6. Ifyouwishpeopletobeabletoconsumealcoholonthepremises,pleasetick‘onthepremises’.Ifyouwishpeopletobeabletopurchasealcoholtoconsumeawayfromthepremises,pleasetick‘offthepremises’.Ifyouwishpeopletobeabletodoboth,pleasetick‘both’.
  7. Pleasegiveinformationaboutanythingintendedtooccuratthepremisesorancillarytotheuseofthepremiseswhichmaygiverisetoconcerninrespectofchildren,regardlessofwhetheryouintendchildrentohaveaccesstothepremises,forexample(butnotexclusively)nudityorsemi-nudity,filmsforrestrictedagegroupsorthepresenceofgamingmachines.
  8. Pleaselistherestepsyouwilltaketopromoteallfourlicensingobjectivestogether.
  9. Theapplicationformmustbesigned.
  10. Anapplicant’sagent(forexamplesolicitor)maysigntheformontheirbehalfprovidedthattheyhaveactualauthoritytodoso.
  11. Wherethereismorethanoneapplicant,eachoftheapplicantsortheirrespectiveagentsmustsigntheapplicationform.
  12. Thisistheaddresswhichweshallusetocorrespondwithyouaboutthisapplication.