Designed & Printed by Slough Borough Council TL/3641/02-08-18
Application date Licence expiry date
Receipt number Licence fee
Licence start date
OFFICE USE ONLY
I hereby certify that to the best of my knowledge and belief that the information I have given is correct. I have given it
knowing that I shall be liable to prosecution if I have knowingly or recklessly made a false statement or omitted any material
particular to this application. I accept that Slough Borough Council (SBC) reserves the right to clarify any of my answers or
require further information in accordance with the provisions of the Town Police Clauses Act 1847, the Local Government
Miscellaneous Provisions Act 1976 and any other modification or re-enactment thereof.
I acknowledge that the licence issued to me as detailed above, remains the property of SBC and must be returned to the
council on demand. I understand I must return the licence (including the ID badge) within7 days following the revocation or
suspension of the licence under section 60 of the Local Government (Miscellaneous Provisions) Act 1976.
Officer signature Date
Policy booklet issued
Signature of applicant Date