9
Please return your completed form to:
Licensing
Harlow Council
Civic Centre
The Water Gardens
College Square
Harlow CM20 1WG
Tel: 01279 446005
Section 9. Checklist (for all applicants)
I have (please tick appropriate boxes):
enclosed a basic disclosure form dated wit
each applicant, director and partner
enclosed two passport photographs (collectors only)
enclosed the application fee
enclosed copies of any environmental permit, exemption or
registration
signed the declaration in section 10
Section 10. Declaration (for all applicants)
The information contained in this form is true and accurate to the best of my knowledge and
belief. I understand that if I make a material statement knowing it to be false, or if I recklessly
make a material statement which is false, I will be committing an offence under Schedule 1
paragraph 5 of the Scrap Metal Deale
rs Act 2013, for which I may be prosecuted, and if
convicted, fined.
I understand that the local authority to whom I make my application may consult other
agencies about my suitability to be licensed as a scrap metal dealer, as per section 3(7) of
the Scrap Metal Dealers Act 2013, and that those other agencies may include other local
authorities, the Environment Agency, the Natural Resources Body for Wales, and the police.
I understand that the purpose of the sharing of this data is to form a full assessment of my
suitability to be licensed as a scrap metal dealer. I also understand that the sharing of
information about me may extend to sensitive personal data, such as data about any
previous criminal offences. Some details will also be displayed on a national register, as
required by the Scrap Metal Dealers Act 2013. I hereby expressly consent to this processing
of my data and display of relevant information on the public register.
Signed: Date:
Signed: Date:
Signed: Date:
Signed: Date: