1. Has any individual or the company named on this application form been refused a
licence to retail firework by any local authority or fire authority?
Yes/No
If yes. please give details:
2. Has any individual or the company named on this application form committed, in the
last 5 years, any of the following offences:
a. An offence under Section 11 of the Fireworks Act 2003
b. An offence under Section 12 of the Consumer Protection Act 1987 relating to
the Fireworks (Safety) Regulations 1997.
c. An offence under the Explosives Act 1875 relating to:
• The manufacturer of explosives at an unauthorised place
• Keeping explosives in an unauthorised place
• Exposing for sale gunpowder not properly packaged or labelled
d. An Offence in relation to the use, storage or keeping of fireworks under
the Health & Safety at Work, Etc Act 1974
Yes/No. If yes please give full details.
DECLARATION
I declare that I have checked the information given on this application form and to the
best of my knowledge and belief it is correct.
Signed
Name (printed)
Position
Date
Staffordshire County Council may refuse to grant a licence, or may revoke a licence that it has
granted if the applicant has committed any of the offences mentioned on this application form
If a licence is refused or revoked the applicant may appeal to the Magistrates Court against the
decision. Appeals must be made within 28 days of the refusal or revocation.
The completed application form together with the annual fee of £500 should posted
to:
