Fillable and declaration Before completing this form please read (Dover District Council)

Fill Online, Printable, Fillable, Blank and declaration Before completing this form please read (Dover District Council) Form

Use Fill to complete blank online DOVER DISTRICT COUNCIL pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

and declaration Before completing this form please read (Dover District Council)

On average this form takes 7 minutes to complete

The and declaration Before completing this form please read (Dover District Council) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 27 other fields

Country of origin: UK
File type: PDF

Use our library of forms to quickly fill and sign your Dover District Council forms online.

BROWSE DOVER DISTRICT COUNCIL FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
Disclosure of convictions
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
• 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
2. Forfeiture of a personal licence in the last 5 years
Do not answer this question if you are applying under regulation 8 of the Licensing Act
(Personal licences) Regulations 2005
Please tick
Has any personal licence held by you been forfeited in the last 5 years?
If yes, please provide details below:
No
Name of court
Address of court
Date of forfeiture
Offence which resulted
in the forfeiture
Any additional details
2
3. Relevant or foreign offences
Read Note 1 Please tick
Have you been convicted of any relevant offence or foreign offence?
Yes
No
If you have been convicted of any relevant offences 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 offences 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:
4. Declaration
I declare that I have not been convicted of any relevant offence or any foreign offence
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 not exceeding
level 5 on the standard scale.
SIGNATURE
DATE
3
Notes
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.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

and declaration Before completing this form please read (Dover District Council)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 1 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document