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C H D A L E
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METROPOLITAN !BOROUGH
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C ,Q U N C I L
LOCAL GOVERNMENT (MISC. PROV.) ACT 1982
APPLICATION FOR THE REGISTRATION AS A PERSON CARRYING ON:
A) THE PRACTICE OF ACUPUNCTURE
B) THE BUSINESS OF TATTOOING
C) EAR PIERCING
D) ELECTROLYSIS
E) PIERCING
1. Full Name of Applicant
Postcode:
Tel No:
3. Name under which Business is to be
carried on
4. Address of premises at which
business is to be carried on
5. Registration(s) applied for:
B) Tattooing/ Micro-Pigmentation
C) Ear Piercing
D) Electrolysis
6. Particulars of any convictions under
Section 16 of the Act
- Have you had a registration
7. National Insurance Number
I/We the undersigned, hereby apply for registration in accordance with the above details, under
the provisions of the Local Government (Miscellaneous Provisions) Act 1982, as a person
carrying on the practice of acupuncture or the business of tattooing, ear piercing, electrolysis or
body piercing and enclose the registration fee of £……… which is made up of £161 per person,
per registered activity at the premise address detailed above.
Find out how we use your personal information at rochdale.gov.uk/privacy
Signed…………………………………………………… Date…………………………………………..
*Please note: The practice of forms of body art that is not referred to above or more extreme than ‘common cosmetic body art’
i
s not covered by the Byelaws and would not be covered by any subsequent registration certificate issued
*
PL
EASE RETURN COMPLETED FORM TO Jackie Hall, PUBLIC PROTECTION SERVICE, NUMBER ONE RIVERSID
E,
S
MITH STREET, ROCHDALE, OL16 1XU (PLEASE NOTE WE NO LONGER ACCEPT CHEQUES, YOU WILL
BE
CO
NTACTED TO TAKE PAYMENT BY PHONE
)
