ࡱ> FHE bjbj 12jjCl   8F $j d[!  "   $Q" q$V Q  !     RR p RL+!0[!8$$RConsent of individual to being specified as premises supervisor  FORMTEXT       I [full name of prospective premises supervisor] of  FORMTEXT       [home address of prospective premises supervisor] hereby confirm that I give my consent to be specified as the designated premises supervisor in relation to the application for  FORMTEXT       [type of application] by  FORMTEXT      [name of applicant]  FORMTEXT       relating to a premises licence [number of existing licence, if any] for  FORMTEXT      [name and address of premises to which the application relates] and any premises licence to be granted or varied in respect of this application made by  FORMTEXT       [name of applicant] concerning the supply of alcohol at  FORMTEXT       [name and address of premises to which application relates] I also confirm that I am applying for, intend to apply for or currently hold a personal licence, details of which I set out below. Personal licence number  FORMTEXT      [insert personal licence number, if any] Personal licence issuing authority  FORMTEXT      [insert name and address and telephone number of personal licence issuing authority, if any] Signed  FORMTEXT      Name (please print)  FORMTEXT       Date      PAGE 1 .028:NPR\^b$(*ٸʣ䘊xʣjXʣي#jCJOJQJU^JaJ6CJOJQJ]^JaJ#jjCJOJQJU^JaJ6CJOJQJ]^JaJCJOJQJ^JaJ(jCJOJQJU^JaJmHnHu#jCJOJQJU^JaJjCJOJQJU^JaJCJOJQJ^JaJ6CJOJQJ]^JaJ5CJOJQJ\^JaJ".028`zzzzzsa$$ &`#$/Ifa$$xa$$a$b$$Ifl8 6` 04 la$L$ &`#$/If^La$@ ^@  `b$$ &`#$/Ifa$dx$a$b$$IflT   6` 04 la"$*Ro$$ &`#$/Ifa$$0x^`0a$ $0^`0a$b$$IflZ   6` 04 la*,@BDNPT|~>JL`bdnpt H J ^ zl6CJOJQJ]^JaJ#jCJOJQJU^JaJ#jCJOJQJU^JaJ#jCJOJQJU^JaJ6CJOJQJ]^JaJ(jCJOJQJU^JaJmHnHu#j>CJOJQJU^JaJCJOJQJ^JaJjCJOJQJU^JaJ'RT|~$$ &`#$/Ifa$$a$b$$IflT   6` 04 la>@Jrv$$ &`#$/Ifa$$xa$$@ ^@ a$$a$b$$Ifl< 6` 04 lart $$ &`#$/Ifa$$xa$$a$b$$IflT   6` 04 la H p $$ &`#$/Ifa$$xa$$a$b$$IflT   6` 04 la^ ` b l n t * , @ B D N P T       ޾޾޾޾~޾wwlw^lj0OJQJU^JjOJQJU^J OJQJ^J#jCJOJQJU^JaJ6CJOJQJ]^JaJ#j\CJOJQJU^JaJ6CJOJQJ]^JaJCJOJQJ^JaJ(jCJOJQJU^JaJmHnHujCJOJQJU^JaJ#jCJOJQJU^JaJ$p r * R z$$ &`#$/Ifa$$xa$d$a$b$$Ifl$ T   6` 04 laR T   }}}}}}$$ &`#$/Ifa$$xa$$a$b$$IflT   6` 04 la }$&`#$/Ifb$$Ifl| 6`G04 la$G&`#$/IfPRfhjtvzĿ0JmHnHu0J j0JU jUCJOJQJ^JaJjOJQJU^J OJQJ^JjOJQJU^J jOJQJU^JmHnHu "LNPx$&`#$/Ifb$$Ifl | 6`04 laxz|$a$`$$Ifl  6`04 la/ 01h. A!"#$% jDjDjDvDdText14jDjDjDdjDjDdjDvDdText15vD2Text10 i@@@ Normal CJOJQJ_HaJmH sH tH <A@< Default Paragraph FontJPJ Body Text 2 @ 5$7$8$H$ >*CJaJ, @, Footer  9r ^^ ScheduleHead$$$ G dxda$CJOJQJaJVOV Schedule$$$ G dxa$CJOJQJaJDD Part$$ G a$CJOJQJaJ,@B, Header  9r &)@Q& Page Number8Ob8 T1$da$CJOJQJaJFB@rF Body Text$da$CJOJQJ^JaJ_2@AXYZ\eyz %9:z{$89vw)*STw&'(<=>CPQ\`00000000000000000000000000000000000000000000000000000000000000000000000000000@0@0@0 0 *^  `Rr p R x  DPVeqw%17$06!'w(4:_FtFtFtFtFtFtFtFtFtFtFtFt!48@0(  B S  ?Text15Text10)`;`DWex%8$7(w(;BCCEEFFHIKLNOQ[]`DWex%8$7(w(;BCCEEFFHIKLNOQ[]`DWex%8$7(w(;BCEFFHIKLNOQ[`IMP368L:\Alcohol Licensing\Unit\Unit Tested Application Forms\Local Authority Version\A_42-11A Consent of individual to being specified as premises supervisor.doc Simon SmithdF:\AutoRecovery save of A_42-11A Consent of individual to being specified as premises supervisor.asd Simon SmithL:\Alcohol Licensing\Unit\Live Application Forms\Local Authority Version\A_42-11A Consent of individual to being specified as premises supervisor.doc Simon SmithL:\Alcohol Licensing\Unit\Live Application Forms\Local Authority Version\A_42-11A Consent of individual to being specified as premises supervisor.doc Simon SmithdF:\AutoRecovery save of A_42-11A Consent of individual to being specified as premises supervisor.asd Simon SmithL:\Alcohol Licensing\Unit\Live Application Forms\Local Authority Version\A_42-11A Consent of individual to being specified as premises supervisor.doc Simon SmithL:\Alcohol Licensing\Unit\Live Application Forms\Public version\P_42-11A Consent of individual to being specified as premises supervisor.docPRO117G:\Licensing\REGULATIONS CONSULTATION\FINAL REGULATIONS\forms\050228 Forms final\premises licences and club certificates\P_Website\P_42-11A Consent of individual to being specified as DPS.doc stmbcadmin\\library1\Licencing\nas3.doc stmbcadmint\\nas3\Library1\Licencing\Shared\Liquor Licensing\Application Forms etc - Final Versions\Premises\Consent of DPS.doc |}0k6~H>^lr@^pH^^`.^`.^`.^`. ^`OJQJo( ^`OJQJo( ^`OJQJo( ^`OJQJo(hh^h`. hh^h`OJQJo( ~}| @AXYeyz%9:$89)*w(<=`@ QVRQQL_```` ` `UnknownGz Times New Roman5Symbol3& z Arial?BlissBliss"1hĚĚ-CFV {SY0dS?MG2qHPPART ATSO120 stmbcadminOh+'0  0 < H T`hpxPART AARTTSO120SO1SO1Normal stmbcadmin2mbMicrosoft Word 9.0@F#@.] @P @P V՜.+,0 hp  DCMSPA S PART A Title  !#$%&'()*+,-./012346789:;<>?@ABCDGRoot Entry F`OIData 1Table"$WordDocument12SummaryInformation(5DocumentSummaryInformation8=CompObjjObjectPool`O`O  FMicrosoft Word Document MSWordDocWord.Document.89q