ࡱ> '` bjbj$$ FF0*t>>>|?t?ti@.CDDDDDDggggggg$khpmhgEDDEEgDDhHHHEDDgHEgHHbleD@ POỎv>`Fld*eh0iCdJmGvmTeme$D"EH)E=EDDDggBHXDDDiEEEEttt(81d ttt81ttt  Application for a minor variation to a premises licence or club premises certificate under the Licensing Act 2003 PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST Before completing this form please read the Guidance Notes at the end of the form, especially Note 1. 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 in black ink. Use additional sheets if necessary. Once completed please send your application to the relevant licensing authority. You may wish to keep a copy of the completed form for your records.  FORMTEXT       (Insert name(s) of applicant) being the premises licence holder(s) / club holding a club premises certificate, apply to vary a premises licence under section 41A / club premises certificate under section 86A of the Licensing Act 2003 for the premises described in Part 1 below. Postal address of premises (or, if none, ordnance survey map reference, or description)  FORMTEXT       Post town  FORMTEXT       Post Code  FORMTEXT       Part 1  Premises details Telephone number at premises (if any)  FORMTEXT       Premises licence number/club premises certificate number  FORMTEXT        Brief description of premises (Please see Guidance Note 2)  FORMTEXT       Part 2  Applicant Details Please tick byes I am/ we are the premises licence holder/club premises certificate holder  FORMCHECKBOX  Contact phone number in working hours (if any)  FORMTEXT       Applicant Postal address IF DIFFERENT FROM PREMISES ADDRESS  FORMTEXT       Post town  FORMTEXT       Postcode  FORMTEXT       Please provide email address if you would prefer us to contact you by email (optional)  FORMTEXT       Part 3  Proposed variation(s) Please tick (yes Do you want the proposed variation to have effect as soon as possible?  FORMCHECKBOX  Day Month Year  FORMTEXT       If not, from what date do you want the variation to take effect? Please describe the proposed variation(s) in detail in the box below and explain why you consider that they could not have an adverse effect on the promotion of any of the licensing objectives (See Guidance Note 1). This should include whether new or increased levels of licensable activities will be taking place indoors or outdoors (indoors may include a tent): Details of proposed variations (Please see Guidance Note 3)  FORMTEXT        Details of proposed variations (Continued)  FORMTEXT       Part 4  Operating Schedule Please tick those parts of the Operating Schedule which would be subject to change if this application to vary were successful. Provision of regulated entertainment Please tick ( yes a. plays  FORMCHECKBOX  b. films  FORMCHECKBOX  c. indoor sporting events  FORMCHECKBOX  d. boxing or wrestling entertainment  FORMCHECKBOX  e. live music  FORMCHECKBOX  f. recorded music  FORMCHECKBOX  g. performances of dance  FORMCHECKBOX  h. anything of a similar description to that falling within (e), (f) or (g)  FORMCHECKBOX  Provision of entertainment facilities for Please tick (yes i. making music  FORMCHECKBOX  j. dancing  FORMCHECKBOX  k. entertainment of a similar description to that falling within (i) or (j)  FORMCHECKBOX  Provision of late night refreshment  FORMCHECKBOX  Sale by retail of alcohol  FORMCHECKBOX  (Note that this can only relate to reducing licensed hours, or moving them without any overall increase between 7am and 11pm) Enclosures I have enclosed the premises licence/club premises certificate  FORMCHECKBOX  I have enclosed the relevant part of the premises licence/ club premises certificate  FORMCHECKBOX  I have included a copy of the plan (necessary if the proposed variation will affect the layout)  FORMCHECKBOX  If you have not ticked one of the previous three boxes, please explain why in the box below. Reasons why you have failed to enclose the premises licence/club premises certificate or relevant parts.  FORMTEXT        Any further information to support your application. (See Guidance Note 4)  FORMTEXT        CHECKLIST: Please tick ( yes . I have made or enclosed payment of the fee  FORMCHECKBOX  I have enclosed the plan, if appropriate, of the premises  FORMCHECKBOX  in scale [1mm to 100mm], unless otherwise agreed with the licensing authority I have enclosed the premises licence/club premises certificate  FORMCHECKBOX  or relevant part of it or provided an explanation I understand that if I do not comply with the above requirements  FORMCHECKBOX  my application will be rejected. I understand that I am required to advertise my application by posting a white notice at  FORMCHECKBOX  or on the premises for ten consecutive working days commencing on, and including the day after the day when my application is given to the licensing authority. IT IS AN OFFENCE, LIABLE ON CONVICTION TO A FINE UP TO LEVEL 5 ON THE STANDARD SCALE UNDER SECTION 158 OF THE LICENSING ACT 2003 TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION. Part 5 Signatures and Contact Details (See Guidance Note 5) Premises Licence: Signature of applicant (the current premises licence holder) or applicants solicitor or other duly authorised agent. (See Guidance Note 6) If signing on behalf of the applicant, please state your name and in what capacity you are authorised to sign: Signature: Date:  FORMTEXT       Capacity: I / We (insert full name and capacity)  FORMTEXT       sign on behalf of and have authority to bind the applicant. Where the premises licence is jointly held, signature of 2nd applicant (the current premises licence holder) or 2nd applicant s solicitor or other authorised agent (See Guidance Note 7). If signing on behalf of the applicant please state in what capacity. Signature: Date:  FORMTEXT       Capacity: I / We (insert full name and capacity)  FORMTEXT       sign on behalf of and have authority to bind the applicant. Where the premises is a club I (insert full name)  FORMTEXT       make this application on behalf of the club and have authority to bind the club Signature: Date:  FORMTEXT       Capacity: I / We (insert full name and capacity)  FORMTEXT       sign on behalf of and have authority to bind the applicant. Contact name (where not previously given) and address for correspondence associated with this application. (See Guidance Note 8)  FORMTEXT       Post town  FORMTEXT      Post code  FORMTEXT      Telephone number (if any)  FORMTEXT      If you would prefer us to correspond with you by email your email address (optional)  FORMTEXT       Notes for Guidance 1. General Note: The minor variations process can only be used for variations that could have no adverse impact on the promotion of any of the four licensing objectives. (These are: the prevention of crime and disorder; public safety; the prevention of public nuisance; and the protection of children from harm.) It cannot be used to: extend the period for which the licence or certificate has effect; transfer the licence or certificate from one premises to another; specify, in a premises licence, an individual as the premises supervisor add the sale by retail or supply of alcohol as an activity authorised by a licence or certificate; authorise the sale by retail or supply of alcohol at any time between 11pm and 7am; authorise an increase in the amount of time on any day during which alcohol may be sold by retail or supplied; include the alternative licence condition referred to in section 41D(3) in a premises licence. 2. Description of premises. For example the type of premises, its general situation and layout and any other information which could be relevant to the licensing objectives. This should include any activities in or associated with the use of the premises which may give rise to concern in respect of children regardless of whether you intend children to have access to the premises, for example (but not exclusively) nudity or semi-nudity, films for restricted age groups, the presence of gaming machines, etc. 3. Give full details of all the proposed variation(s). Failure to provide sufficient information may lead to the refusal of your application. Details should include a description of the proposed variation(s) in terms as precise as possible. If you are not precise, the licensing authority may decide that the changes you propose would be potentially broader in scope than you intend and reject your application as not being a minor variation. 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You should cover each of the objectives that could possibly apply to your proposal (or if more than one, to each proposal) and say why you think there could be no adverse impact on that objective. Your application will be assisted by including as much information as you can about this. (However, there is a box at the end of the form for further information, and this should be used for any relevant background information not directly related to the variation). Relevant information includes: a) Variations to licensable activities/licensing hours (all timings should be given in 24 hour clock (e.g. 16.00). Only give details for the days of the week when you intend the premises to be used for the activity), such as: Whether new or increased levels of licensable activities will be taking place indoors or outdoors. Indoors may include a tent; Relevant further details, for example whether music will be amplified or unamplified; Standard days and timing when the activity will take place, including start and finish times; Any seasonal variations in timings, e.g. additional days during the summer; Non-standard timings, e.g. where you wish the activity to go on longer on a particular day such as Christmas Eve. b) Variations to premises/club layout: If you are applying for a variation to the layout of your premises, you must include a revised plan. You should be aware that your application is likely to be refused if the proposed variation could: increase capacity for drinking on the premises; affect access between the public part of the premises and the rest of the premises or the street or public way, e.g. block emergency exits or routes to emergency exits; or impede the effective operation of a noise reduction measure. c) Revisions, removals and additions of conditions: The minor variation process may be used to remove conditions which are out of date or invalid and to revise conditions which are unclear (as long as the intention and effect remains the same). It can also be used to add a new condition volunteered by the applicant or mutually agreed between the applicant and a responsible authority, such as the police or the environmental health authority (subject to impact on the licensing objectives). d) Variations to opening hours: Details of any changes to hours when the premises or club is open to the public. 4. Further information: You should use this box to provide any additional evidence to support your claim that the proposed variation is minor and could not have an adverse impact on the promotion of the licensing objectives. 5. Signatures: The application form must be signed. 6. Authorised agent: An applicants agent (e.g. solicitor) may sign the form on their behalf and, in so doing, will be confirming that they have actual authority to do so. 7. 2nd Applicant: Where there is more than one applicant both applicants or their respective agents must sign the application form. 8. This is the address which we shall use to correspond with you about this application. This might not be the same as the address of the premises or applicant, but these addresses must also be provided. SYMBOL 148 \* MERGEFORMAT .      PAGE \* MERGEFORMAT 1 $a$jkh7mHnHuh7jh7Uhq@ jhq@ U/01h. A!n"n#n$n% / 01h. A!"0#$% 2 001h. A!"0#$% / 01h. A!"0#$% 2 001h. A!"0#$% / 01h. A!"0#$% 2 001h. A!"0#$% / 01h. 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