Personal alcohol licence application form

Before you Start...
Before applying you will need to ensure you have the following documents: Personal Licence Holder Qualification, a Basic DBS certificate dated within 1 month (Page 1 & 2), x2 Passport Style photograph's (one of which should be endorsed) and a right to work document i,e passport, birth certificate or residence permit. Once this application has been submitted it will be reviewed by the Licensing Officer and a payment link will be sent. At this stage your application hasn't been accepted until payment has been received.
Applicant Details
Title
Name

First name

Last name
Middle Name (If any)
Address

Address Line 1

Address Line 2

City

County

Postcode

Country
Email

This should be the licence holder email
Telephone

This should be the licence holder telephone number
Date of Birth
I declare that I am over 18 years of age:
YesNo
Nationality

Other Correspondance address
This section applies if the correspondence details are different to the applicant details.
This is the address the licence should be sent to:
YesNo
Full Name
Other address

Address Line 1

Address Line 2

City

County

Postcode

Country
Other telephone
Other email

Disclosure of Convictions
1. Has any personal licence held by you been forfeited in the last 5 years (If yes provide further details)
YesNo
You must provide details of the date of conviction, the name and location of the convicting court, offence of which you were convicted and the sentence imposed:
2. Have you been convicted of any relevant offence or foreign offence? (If yes provide further details)
YesNo
If you have been convicted of any relevant offences you must provide details for each conviction of the date of conviction, the name and location of the convicting court, offence of which you were convicted and the sentence imposed:
Declaration
I declare that I have not been convicted of any relevant offence or any foreign offence.
YesNo
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.
YesNo

Document Upload
You should attach all documents required in support of this application:
Right to Work

Your right to work document is a document in which allows you to work in the UK. This document may be a British/EU passport, Birth certificate or residence permit
Personal Licence Holder Qualification

This document must be a recognised personal licence qualification.
Basic DBS Certificate Page 1

Page 2 of your DBS certificate, this should be a clear copy showing the full page
Basic DBS Certificate Page 2

Page 2 of your DBS certificate, this should be a clear copy showing the full page
Passport Style Photograph

A photograph which is taken on a clear background.
Passport Style Photograph Endorsed

Recognised and acceptable signatories include : Accountant, Architect, Barrister, Dentist, Doctor, Lecturer, Magistrate, Minister, Nurse, Police Officer, Reverend, Solicitor, Teacher, Vet, Managing Director
Proof of Address

Proof of address dated within the last 3 months i.e utility bill or bank statement

I am entitled to work in the UK and am not subject to a condition preventing me from doing work relating to the carrying on of a licensable activity. I understand that my licence will become invalid if I cease to be entitled to live and work in the UK. 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 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 of any amount. It is an offence under section 24B of the Immigration Act 1971 to work illegally.
YesNo