Application for the grant of a Personal Licence
under s117 of the Licensing Act 2003 made
by the holder of a licensing qualification
or a person of prescribed description
(Form Last Revised October 2018)
Licensing Act 2003
East Lindsey District Council – Licensing Authority
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Please read the following instructions, guidance notes at the end of the form and any guidance leaflets
enclosed with this application before completing your application form.
1. If you are completing the form by hand please write legibly in BLOCK CAPITALS and write in BLACK INK.
2. In all cases ensure that your answers are inside the boxes. Use additional sheets as necessary.
3. Incomplete or inadequate applications will be rejected and will be required to be resubmitted to the
Licensing Authority.
4. The application must be returned to:
The Licensing Team
East Lindsey District Council
Tedder Hall
Manby Park
LOUTH
Lincolnshire
LN11 8UP
5.
You may only apply to East Lindsey District Council if you normally reside within the East Lindsey District.
Application for a Personal Licence
The following sections of this document indicate how you apply for a Personal Licence.
Requirements for a new application for a Personal Licence
Complete the application form
Be over 18
Hold a Licensing Qualification (see below) that has been accredited by the Secretary
of State. The aim of this provision is to ensure that licence holders are aware of
licensing law and the wider social responsibilities attached to the sale of alcohol
Submit a DBS Basic Disclosure (criminal conviction certificate which is not more
than one month old). The purpose of the check is to determine if there are any
relevant offences recorded against the applicant (see below for further details)
Submit a signed statement relating to any convictions for a relevant offence, foreign offence
or the receipt of a civil immigration penalty
The application fee of £37.00 (cheques made payable to East Lindsey District Council)*
Submit 2 passport sized photographs (one of which must be endorsed as a
true likeness – see Appendix 2 of this Authority’s guidance leaflet ‘Licensing
Act 2003 - Personal Licences’ for further details regarding photographs)
Submit evidence of your entitlement to work in the UK
*Please note that we no longer accept cash payments for licence application fees.
We are able to take credit or debit card payments over the telephone
or in person at The Council’s Tedder Hall offices.
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Criminal Conviction Certificates
DBS Disclosure - We are advised that the Basic DBS Disclosure (criminal conviction certificate) can be
obtained from the Disclosure and Barring Service’s website at www.gov.uk/request-copy-criminal-record.
For further information (including the cost of a disclosure) telephone 03000 200 190.
Licensing Qualifications
The original certificate for your licensing qualification must be submitted with your application.
An up to date list of acceptable qualifications can be found on the www.gov.uk website.
Contact the bodies (shown on the www.gov.uk website) direct for information on courses, costs and
availability in your area.
Relevant Offences or Equivalent Foreign Offences or Civil
Immigration Penalties that Must be Declared
When submitting an application for a Personal Licence you are required to declare any relevant offences or
equivalent foreign offences or civil immigration penalties you may have, unless they are regarded as “spent”
under the Rehabilitation of Offenders Act 1974. The information you give will be treated in confidence and
will only be taken into account in relation to your application.
Appendix 1 of this Authority’s guidance leaflet “Licensing Act 2003 - Personal Licences” lists the relevant
offences or equivalent foreign offences, which must be declared in an application for a Personal Licence
(unless they are spent under the terms of the Rehabilitation of Offenders Act).
Duty to Notify the Licensing Authority of Convictions During
Application Period
Where an applicant for the grant of a personal licence is convicted of a Relevant Offence or a Foreign Offence
or receives a civil immigration penalty during the application period, they must notify the conviction to the
Authority to which the application was made as soon as reasonably practicable.
A person commits an offence if they fail to comply without a reasonable excuse. If a person is found guilty,
they are liable to a fine not exceeding level 4 on the standard scale, currently £2,500.
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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
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
E-MAIL ADDRESS (if you would prefer us to correspond with you by e-mail)
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2
Address for correspondence associated with this application (if different to
the address above)
Post town
Post code
TELEPHONE NUMBERS
Daytime
Evening
Mobile
E-MAIL ADDRESS (if you would prefer us to correspond with you by e-mail)
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. 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
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3
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
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
Your information will be processed in accordance with the law, in particular the Data
Protection Act 1998. The information that you provide will only be used for Council
purposes unless there is a legal authority to do otherwise.
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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 Ca
rd 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 st
ay 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 Insurance number and their name
issued by a Government agency or a previous empl
oyer.
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5
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 h
older 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 Gov
ernment 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.
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
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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.
9
10
[Insert name and address of relevant licensing authority and its reference number (optional)]
Disclosure of convictions and civil immigration penalties and
declaration
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
a
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
a
Mr
Mrs Miss Ms Other (please state)
Surname
Forenames
2. Forfeiture by a court or revocation by a licensing authority of a personal
licence in the last 5 years
Please tick a
Has any personal licence held by you been forfeited or revoked in the
last 5 years?
If yes, please provide details below:
Yes
No
Name of court/licensing
authority
Address of court
Date of
forfeiture/revocation
Offence which resulted
in the
forfeiture/revocation
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2
Any additional details
3. Relevant or foreign offences and civil immigration penalties
Read Note 1 Please tick
a
Have you been convicted of any relevant offence or foreign offence or
been required to pay a civil immigration penalty?
Yes
If you have been convicted of any relevant offence you must provide details for each
conviction of the date of conviction, the name and location of the convicting court,
offence of which you were convicted and the sentence imposed:
If you have been convicted of any foreign offence you must provide details for each
conviction of the date of conviction, the name and location of the convicting court,
offence of which you were convicted and the sentence imposed:
If you have been convicted of any foreign offence you must provide details for each
conviction of the date of conviction, the name and location of the convicting court,
offence of which you were convicted and the sentence imposed:
12
3
4. Declaration
I declare that I have not been convicted of any relevant offence or any foreign
offence or been required to pay a civil immigration penalty
SIGNATURE
DATE
5. Declaration
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 or renewal 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
NOTES
1. Relevant or foreign offences
Relevant offences are the offences listed in Schedule 4 to the Licensing Act 2003:
The meaning of foreign offence is dealt with in section 113 of the Licensing Act
2003.
If you are the holder of a justices’ licence and you are applying for a personal licence
under regulation 8 of the Licensing Act (Personal licences) Regulations 2005 see
paragraphs 23 and 28 in Part 3 of Schedule 8 to the Licensing Act 2003 for the
information you are required to give.
If you are convicted of any relevant or foreign offence during the period between
when your application is made and when your application is determined or
withdrawn, you must notify the authority to which your application was made. Failure
to do so without reasonable excuse could lead to prosecution and a fine not
exceeding level 4 on the standard scale.
2. Civil immigration penalty
An
Immigration penalty means a penalty under either section 15 of the Immigration,
Asylum and Nationality Act 2006 or section 23 of the Immigration Act 2014.
Your information will be processed in accordance with the law, in particular the Data
Protection Act 1998. The information that you provide will only be used for Council
purposes unless there is a legal authority to do otherwise.
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3
4. Declaration
I declare that I have not been convicted of any relevant offence or any foreign
offence or been required to pay a civil immigration penalty
SIGNATURE
DATE
5. Declaration
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 or renewal 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
NOTES
1. Relevant or foreign offences
Relevant offences are the offences listed in Schedule 4 to the Licensing Act 2003:
The meaning of foreign offence is dealt with in section 113 of the Licensing Act
2003.
If you are the holder of a justices’ licence and you are applying for a personal licence
under regulation 8 of the Licensing Act (Personal licences) Regulations 2005 see
paragraphs 23 and 28 in Part 3 of Schedule 8 to the Licensing Act 2003 for the
information you are required to give.
If you are convicted of any relevant or foreign offence during the period between
when your application is made and when your application is determined or
withdrawn, you must notify the authority to which your application was made. Failure
to do so without reasonable excuse could lead to prosecution and a fine not
exceeding level 4 on the standard scale.
2. Civil immigration penalty
An
Immigration penalty means a penalty under either section 15 of the Immigration,
Asylum and Nationality Act 2006 or section 23 of the Immigration Act 2014.
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Data Protection Notice - Personal Licence Application under the Licensing Act 2003
East Lindsey District Council is a Data Controller and can be contacted at:
Tedder Hall, Manby Park, Louth, Lincolnshire, LN11 8UP
Tel: 01507 601111
The Data Protection Officer for this Authority can be contacted at the same address.
We are collecting your personal data in order to process your licence application under the Licensing Act
2003 as we are the Licensing Authority.
Your personal data may be shared in the following ways as part of this application:
The law requires us to verify that applicants for personal licences have the right to work in the UK. Where
necessary, we may need to verify your information with the Home Office.
The Council is required by law to disclose information about personal licence holders to the Cabinet Office
as part of the National Fraud Initiative. More details are available on our website.
The Council may also share personal information with the Police as part of the licensing process. Any
information sharing will be managed in accordance with relevant privacy and data protection legislation.
Your data will not be shared with third parties but may be used for Council purposes, in order to prevent
or detect crime, to protect public funds or where we are required or permitted to share data under other
legislation.
Some limited Premises User / Licence Holder information will be made available to the public as the
Licensing Act 2003 requires us to maintain a Register of Licence Applications. The Register includes the name
of the licence holder.
In line with our retention policy your data will be kept for the period of time that you hold a licence with
this Authority and then for a further 6 years after your licence expires. The data will then be deleted /
destroyed.
We also keep data for six years from the resolution of an unsuccessful licence application or the resolution
of legal proceedings.
You have the right to access your data and to rectify mistakes, erase, restrict, object or move your data
in certain circumstances. Please contact the Data Protection Officer for further information or go to our
website where your rights are explained in more detail. If you would like to receive an explanation of your
rights in paper format please contact the Data Protection Officer.
Any complaints regarding your data should be addressed to the Data Protection Officer in the first instance.
If the matter is not resolved you can contact the Information Commissioner’s Office at:
Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF
Tel: 0303 123 1113
If you do not provide the information required on the form then we will not be able to process your licence
application.
For further information on our Data Protection Policies please go to our website: www.e-lindsey.gov.uk
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CALE AGPL V10 1118
If you would like this information
in a different format, please
contact us on 01507 601111
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