Minor Variation Application Premises details Online payment receipt reference Licence number Licence holder name Registered number (If applicable) Premises name Address Address Line 1 Address Line 2 City County Postcode Country Phone number for the premises Email Brief description of premises Next Page Applicant details These are the details of the licence holder Individual applicant name First name Last name Company name (if applicable) Address Address Line 1 Address Line 2 City County Postcode Country Email Phone number Previous PageNext Page Proposed variation Do you want the proposed variation to have effect as soon as possible? YesNo If you selected no, what date do you want the variation to take effect? Do you want the proposed variation to have effect in relation to the introduction of the late night levy? YesNo 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): Continued... Select which of the following activities would be subjct to change PlaysFilmsIndoor Sporting EventsBoxing or Wrestling EntertainmentLive MusicRecorded MusicPerformance of DanceAnything of a similar description to any of the aboveLate Night RefreshmentSupply of Alochol (Note that this can only relate to reducing licensed hours, or moving them without any overall increase between 7am and 11pm)Other Previous PageNext Page Document upload Current Plan of the premises New plan of the premises (this is necessary if the proposed variation will affect the layout) Premises or Club Licence Additional documents Previous PageNext Page Declerations Reasons why you have not enclosed the premises licence/club premises certificate or relevant parts. Input NA if this does not apply I have enclosed the plan, if appropriate, of the premises in scale [1mm to 100mm], unless otherwise agreed with the licensing authority YesNot applicable I have enclosed the premises licence/club premises certificate or relevant part of it or provided an explanation? YesNo I understand that if I do not comply with the above requirements my application will be rejected. I understand I understand that I must now advertise my application for a continuous period beginning on the first working day after the day on which the application was given to the relevant licensing authority and ending at the expiry of the ninth consecutive working day after that day. I understand I understand that it is an offence, under section 158 of the Licensing Act 2003, to make a false statement in or in connection with this application. those who make a false statement may be liable on summary conviction to a fine of any amount. I understand Previous PageNext Page Alternative correspondance details Name First name Last name Address Address Line 1 Address Line 2 City County Postcode Country Email Phone number Previous Page Submit