Renfrewshire Licensing Board
Licensing (Scotland) Act 2005, sections 29 and 31
APPLICATION FOR VARIATION OF PREMISES LICENCE/PROVISIONAL
PREMISES LICENCE*
By current licence holder where no transfer is taking place
If you are completing this form by hand, please write legibly in block
capitals using ink.
Please send to:-
Depute Clerk to the Licensing Board
Renfrewshire Licensing Board
Renfrewshire House
Cotton Street
Paisley PA1 1TT
Question 1 – DETAILS OF PREMISES
Name, address, postcode and premises licence number of premises.
Question 2 – APPLICANT INFORMATION
Please provide full name, address, postcode, phone number and e-mail address
of applicant.
Question 3 - MINOR VARIATIONS
3(a) Do you consider the proposed variation to be a
minor variation? Yes No
(If YES, please answer the rest of question 3. If NO, go to question 4)
3(b) Do you propose a variation to the layout plan which is not inconsistent with
the operating plan for the Premises? Yes No
(if YES, please give details of the proposed variation below)
Please submit 7 sets of plans showing the proposed layout of the premises
with this application.
3(c) Do you propose to restrict the terms on which children and young persons
are admitted to the premises? Yes No
(if YES, please give details of the proposed variation below) Please
submit an amended operating plan with this application.
3(d) Do you propose to vary the information contained in the licence relating to
the premises manager, including a variation to substitute a new premises
manager? Yes No
(if YES, please go to question 5 below)
3(e) Do you propose any other variation as prescribed by Section 29(6)(d) of
the 2005 Act? Yes No
(if YES, please give details of the proposed variation below)
Question 4 - OTHER VARIATIONS
4(a) Do you propose a variation to the conditions to which the licence is subject
(other than those to which the licence is subject by virtue of Section
27(1))? Yes No
(if YES, please give details of the proposed variation below)
4(b) Do you propose to vary any of the information contained in the operating
plan contained in the licence? Yes No
(if YES, please give details of the proposed variation below)
Please submit a copy of the proposed operating plan with this application.
4(c) Do you propose a variation to the layout plan contained in
the licence? Yes No
(if YES, please give details of the proposed variation below)
Please submit 7 sets of the proposed layout plans with this application.
4(d) Do you propose to vary any other information contained or referred to in
the licence, including an addition, deletion or
other modification? Yes No
(if YES, please give details of the proposed variation below)
Question 5 - VARIATION TO SUBSTITUTE NEW PREMISES MANAGER
Please provide details below of the name, address and personal licence number
of the Existing Premises Manager.
Proposed Premises Manager
Please submit the Personal Licence with this application.
5(a) Name and telephone number
5(b) Date and place of birth
5(c) Contact address, including postcode
5(d) Email address
5(e) Personal licence
Date of issue Name of Licensing Board issuing Reference no. of
personal licence
5(f) Is the variation to take effect during the application period? Yes No
If the answer to the above question is NO, please provide below the date
from which the variation is to take effect.
DECLARATION BY APPLICANT OR AGENT ON BEHALF OF
APPLICANT
If signing on behalf of the applicant please state in what capacity.
The contents of this Application are true to the best of my knowledge and belief.
Signature …………………………………… * (see note below)
Date …………………………………………
Capacity ……………………………………. APPLICANT/AGENT (delete as
appropriate)
Telephone number and email address of signatory ……………………
I have enclosed the relevant documents with this application – please tick
the relevant boxes
Premises Licence
Letter explaining why the Premises Licence Has not
been produced.
Operating Plan**
Layout plans**
Personal Licence of the Proposed Premises Manager
Fee
* Data Protection Act 1998
The information on this form may be held on an electronic public register which
may be available to members of the public on request.
** Where the proposed variation affects the current layout plan, please submit 7
sets of plans showing the proposed new layout of the premises. Where the
proposed variation affects the current operating plan, please submit an operating
plan including the proposed variations.
FEES
1. Application for Minor Variation (except 2. below) £20
2. Application for Variation which includes an “immediate effect”
change of the Premises Manager details
£31
3. Application for Major Variation £175
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