Sex establishment application Online receipt reference Type of application RenewalNew Applicant details Individual name First name Last name Home address Address Line 1 Address Line 2 City County Postcode Country Date of birth This is required if you are an individual applying Limited Company Limited Company address Address Line 1 Address Line 2 City County Postcode Country What type of company is the applicant (e.g. public, private, limited by share or guarantee etc.? (If applicable) Email Phone Have you been resident in the United Kingdom throughout a period of six months immediately preceding the date of this application? YesNo If no provide details: What is the nature of the applicant’s interest in the premises? FreeholdLeasehold If the applicant’s interest in the premises is leasehold, state the name and address of the landlord. Is the whole of the business owned by the applicant? YesNo If no provide details of joint owners including contact information: Next Page Premises details Trading as name Premises address Address Line 1 Address Line 2 City County Postcode Country Are the whole of the premises to be used under the licence? YesNo If no provide details: Are the premises which are to be used so constructed or adapted as to permit access to and from the premises for members of the public who are disabled? YesNo Previous PageNext Page Operating schedule Does the premises benefit from a Alcohol Licence? YesNo If yes provide the licence number: Opening hours (If day does not apply put NA) Include start and from Monday Tuesday Wednesday Thursday Friday Saturday Sunday Seasonal timings i.e bank holidays: Are the premises to be used as a sex shop? YesNo Are the premises to be used as a sex cinema? YesNo Are the premises to be used as a sexual entertainment venue? YesNo Previous PageNext Page Disclosure of convictions Have you any convictions recorded against you? Or if a body corporate or unincorporated body any convictions recorded against that body or any of its Directors or other persons responsible for its management? YesNo If the answer to the above question is yes, give the names of those persons concerned, full details of the other business and the nature and extent of the connection. Is the applicant or any person whose name is given above concerned in any way financially or otherwise with any other business which controls, manages or supplies sex establishments? YesNo You should state the details including; date of conviction offence, sentence (including suspended sentence) If a renewal, since you last applied for a licence: Are you (or, if a corporate or unincorporated body, that body) disqualified from holding a licence for a sex establishment? YesNo If yes provide details: Have you ever been refused a licence for a sex establishment? YesNo If yes provide details of Local Authority including dates Previous PageNext Page Declaration I declare that I have not been convicted of any relevant offence or any foreign offence. I Declare 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. I Declare Upload documents Plan Right to work (Individuals) Previous Page Submit