Fillable Application for a personal licence (Dover District Council)

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Application for a personal licence (Dover District Council)

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Application for a personal licence
Before completing this form please read the guidance notes at the end of the form.
If you are completing this form by hand please write legibly in block capitals. In all
cases ensure that your answers are inside the boxes and written or typed in black
ink. Use additional sheets if necessary.
You may wish to keep a copy of the completed form for your records.
1. Your personal details
TITLE Please tick
Mr Mrs Miss Ms Other (please state)
Surname
Forenames
PREVIOUS NAMES (if relevant) please enter details of any previous names or
maiden names. Please continue on a separate sheet if necessary.
TITLE Please tick
Mr Mrs Miss Ms Other (please state)
Surname
Forenames
Date of Birth
Nationality
I am 18 years old or over. Please tick
Yes
No
ADDRESS WHERE ORDINARILY RESIDENT (We will use this address to
correspond with you unless you complete the separate correspondence box
below).
Post town Post code
TELEPHONE NUMBERS
Daytime
Evening
Mobile
FAX NUMBER
EMAIL
2
Address for correspondence associated with this application (if different to
the address above)
Post town
TELEPHONE NUMBERS
Daytime
Evening
Mobile
Email
2. Your licensing qualifications
Read Note 1 Please tick yes
Please indicate below which one of these statements applies to you:
1. I hold an accredited licensing qualification
2. I hold a certified qualification
3. I hold an equivalent qualification
4. I am a person of prescribed description
If you have ticked either of statements 1, 2 or 3 please provide details of your
qualification in the box below (name of qualification, date of issue, issuing body) and
please enclose your qualification with your application.
If you have ticked statement 4, please provide evidence that you are a person of
prescribed description.
3
3. Previous or outstanding applications for a personal licence
Note: You may only hold one personal licence at a time. Please tick
Do you currently hold a personal licence?
Yes
No
Do you currently have any outstanding applications for a personal
licence, with this or any other licensing authority?
Yes
No
Has any personal licence held by you been forfeited in the last 5
years?
Yes
No
Licensing Authority
Licence number
Date of issue
Any further details
4. CHECKLIST:
I have Please tick yes
• enclosed two photographs of myself, one of which is endorsed as a true
likeness of me by a solicitor or notary, a person of standing in the
community or any individual with a professional qualification
• enclosed any licensing qualification I hold or proof that I am a person of
prescribed description
• enclosed a criminal conviction certificate or a criminal record certificate
or the results of a subject access search of the police national computer
by the National Identification Service
• enclosed a completed disclosure of criminal convictions and declaration
form (Schedule 3)
• included a proof of my right to work in the United Kingdom (see note 2)
• made or enclosed payment of the fee for the application
4
5. Declaration
I am entitled to work in the UK and am not subject to a condition preventing
me from doing work relating to the carrying on of a licensable activity. I
understand that my licence will become invalid if I cease to be entitled to live
and work in the UK.
The information contained in this form is correct to the best of my knowledge
and belief.
It is an offence knowingly or recklessly to make a false statement in or in connection
with an application for the grant of a personal licence. (A person is to be treated as
making a false statement if he produces, furnishes, signs or otherwise makes use of
a document that contains a false statement). To do so could result in prosecution
and a fine of any amount. It is an offence under section 24B of the Immigration Act
1971 to work illegally.
SIGNATURE
DATE
5
NOTES
Information on the Licensing Act 2003 is available on legislation.gov.uk
or from your local licensing authority.
1. Licensing qualifications
Licensing qualifications are dealt with in section 120(8) and (9) of the Licensing Act 2003.
2. Right to work/immigration status:
A personal licence may not be issued to an individual or an individual in a partnership
which is not a limited liability partnership who is resident in the UK who:
• does not have the right to live and work in the UK; or
• is subject to a condition preventing him or her from doing work relating to the
carrying on of a licensable activity.
Any personal licence issued in respect of an application made on or after 6 April 2017 will
become invalid if the holder ceases to be entitled to work in the UK.
Applicants must demonstrate that they have the right to work in the UK and are not
subject to a condition preventing them from doing work relating to the carrying on of a
licensing activity. They do this by providing with this application copies or scanned copies
of the following documents (which do not need to be certified).
Documents which demonstrate entitlement to work in the UK
• An expired or current passport showing the holder, or a person named in the
passport as the child of the holder, is a British citizen or a citizen of the UK and
Colonies having the right of abode in the UK [please see note below about which
sections of the passport to copy].
• An expired or current passport or national identity card showing the holder, or a
person named in the passport as the child of the holder, is a national of a
European Economic Area country or Switzerland.
• A Registration Certificate or document certifying permanent residence issued by
the Home Office to a national of a European Economic Area country or
Switzerland.
• A Permanent Residence Card issued by the Home Office to the family member of
a national of a European Economic Area country or Switzerland.
• A current Biometric Immigration Document (Biometric Residence Permit) issued
by the Home Office to the holder indicating that the person named is allowed to
stay indefinitely in the UK, or has no time limit on their stay in the UK.
• A current passport endorsed to show that the holder is exempt from immigration
control, is allowed to stay indefinitely in the UK, has the right of abode in the UK,
or has no time limit on their stay in the UK.
• A current Immigration Status Document issued by the Home Office to the holder
with an endorsement indicating that the named person is allowed to stay
indefinitely in the UK or has no time limit on their stay in the UK, when produced
in combination with an official document giving the person’s permanent National
6
Insurance number and their name issued by a Government agency or a previous
employer.
• A full birth or adoption certificate issued in the UK which includes the name(s) of
at least one of the holder’s parents or adoptive parents, when produced in
combination with an official document giving the person’s permanent National
Insurance number and their name issued by a Government agency or a previous
employer.
• A birth or adoption certificate issued in the Channel Islands, the Isle of Man or
Ireland when produced in combination with an official document giving the
person’s permanent National Insurance number and their name issued by a
Government agency or a previous employer.
• A certificate of registration or naturalisation as a British citizen, when produced
in combination with an official document giving the person’s permanent National
Insurance number and their name issued by a Government agency or a previous
employer.
• A current passport endorsed to show that the holder is allowed to stay in the UK
and is currently allowed to work and is not subject to a condition preventing the
holder from doing work relating to the carrying on of a licensable activity.
• A current Biometric Immigration Document (Biometric Residence Permit) issued
by the Home Office to the holder which indicates that the named person can
currently stay in the UK and is allowed to work relation to the carrying on of a
licensable activity.
• A current Residence Card issued by the Home Office to a person who is not a
national of a European Economic Area state or Switzerland but who is a family
member of such a national or who has derivative rights or residence.
• A current Immigration Status Document containing a photograph issued by the
Home Office to the holder with an endorsement indicating that the named person
may stay in the UK, and is allowed to work and is not subject to a condition
preventing the holder from doing work relating to the carrying on of a licensable
activity when produced in combination with an official document giving the
person’s permanent National Insurance number and their name issued by a
Government agency or a previous employer.
• A Certificate of Application, less than 6 months old, issued by the Home Office
under regulation 17(3) or 18A (2) of the Immigration (European Economic Area)
Regulations 2006, to a person who is not a national of a European Economic
Area state or Switzerland but who is a family member of such a national or who
has derivative rights of residence.
• Reasonable evidence that the person has an outstanding application to vary their
permission to be in the UK with the Home Office such as the Home Office
acknowledgement letter or proof of postage evidence, or reasonable evidence
that the person has an appeal or administrative review pending on an immigration
decision, such as an appeal or administrative review reference number.
7
• Reasonable evidence that a person who is not a national of a European
Economic Area state or Switzerland but who is a family member of such a
national or who has derivative rights of residence in exercising treaty rights in the
UK including:-
• evidence of the applicant’s own identity – such as a passport,
• evidence of their relationship with the European Economic Area family
member – e.g. a marriage certificate, civil partnership certificate or birth
certificate, and
• evidence that the European Economic Area national has a right of permanent
residence in the UK or is one of the following if they have been in the UK for
more than 3 months:
(i) working e.g. employment contract, wage slips, letter from the employer,
(ii) self-employed e.g. contracts, invoices, or audited accounts with a bank,
(iii) studying e.g. letter from the school, college or university and evidence of
sufficient funds; or
(iv) self-sufficient e.g. bank statements.
Family members of European Economic Area nationals who are studying or financially
independent must also provide evidence that the European Economic Area national and
any family members hold comprehensive sickness insurance in the UK. This can include
a private medical insurance policy, an EHIC card or an S1, S2 or S3 form.
Original documents must not be sent to licensing authorities. If the document copied
is a passport, a copy of the following pages should be provided:-
(i). any page containing the holder’s personal details including nationality;
(ii) any page containing the holder’s photograph;
(iii) any page containing the holder’s signature;
(iv) any page containing the date of expiry; and
(v) any page containing information indicating the holder has permission to enter or
remain in the UK and is
permitted to work.
If the document is not a passport, a copy of the whole document should be provided.
Your right to work will be checked as part of your licensing application and this could
involve us checking your immigration status with the Home Office. We may otherwise
share information with the Home Office. Your licence application will not be determined
until you have complied with this guidance.
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Application for a personal licence (Dover District Council)

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Completed 1 January 2021

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