Skin piercing licence - additional practitioners

Local Government (Miscellaneous Provisions) Act 1982 (as amended)
Please tick all that apply
AcupunctureEar piercingOther cosmetic piercingElectrolysisTattooingSemi-permanent skin colouring
Applicant Name

First name

Last name
Business Name
Address

Address Line 1

Address Line 2

City

County

Postcode

Country

If you do not need address line 2, just enter an asterisk (*)
Business Phone
Business Email
Additional Practitioners
Please provide the names of the additional practitioners who you want to be included in the licence
Number of additional practitioners

Please enter the total number of practioners
Please list them individually below. If there are more than 5 you will need to upload a list (this can be Word, Excel, pdf etc) at the bottom of this page.
Name

First name

Last name
Name

First name

Last name
Name

First name

Last name
Name

First name

Last name
Name

First name

Last name
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