Make a representation

Application details
Is this for or against the application?
ForAgainst
Applicant's name (if known)

First name

Last name
Premises name
Premises address

Address Line 1

Address Line 2

City

County

Postcode

Country
Type of application
Application or Licence number (if known)
Responsible authority’s details
Tick appropriate box:
Chief Officer of PoliceFire and Rescue AuthorityLocal Planning AuthorityHealth and Safety AuthorityEnvironmental Health AuthorityBodies recognised as being responsible for protection of children from harmLocal Authority Director of Public HealthLocal Weights and Measures Authority (Trading Standards)Licensing AuthorityHome Office Immigration EnforcementOther
Full name
Job title
Telephone number
Email
Address

Address Line 1

Address Line 2

City

County

Postcode

Country

Representations
Your representation
We object to the application being granted at allWe object to the application being granted in its current form*We are in favour of the application (Skip to other)

*If you choose this option remember to tell us in section 3B what changes you would like to see.
Your representation must be relevant to the effect of the application on the promotion of one or more of the four licensing objectives. Complete the boxes below as fully as possible. If you do not then your representation may not be accepted. Attach supporting documents as necessary.
The licensing objectives
To prevent crime and disorder
Public safety
To prevent public nuisance
The protection of children from harm
Other
Supporting documents
Upload any supporting documents that are necessary
Upload 1
Upload 2
Upload 3

Suggestions/further information
Give any suggested conditions that could be added to the licence to remedy the cause of your representations, or other considerations you would like the Licensing Sub-Committee to take into account.
I understand that this representation may become a public document
I confirm that I understand
Date
If you do make a representation you will be expected to attend the Licensing Sub-Committee hearing and any subsequent appeal proceedings. It is an offence, under section 158 of the Licensing Act 2003, to knowingly or recklessly make a false statement in connection with this representation. This is punishable, on summary conviction, by a fine not exceeding level 5 on the standard scale. This form must be returned within the Statutory Period. Check with the Licensing Section by emailing licensing@trafford.gov.uk
I understand