This form can be completed and submitted by the applicant, or the applicant’s agent (for example, solicitor), providing they have authority to do so.

This process is only for variations that could have no adverse impact on the promotion of any of the four licensing objectives, which are: the prevention of crime and disorder; public safety; the prevention of public nuisance; the protection of children from harm.

Tell us if this is a new application or a resubmission. A resubmission is when the Licensing Authority has informed you that your initial application was rejected and requested that you reapply with the necessary amendments within a specified timescale.

Enter a point of contact for this application. This is where we will send all correspondence, including payment information.

I/We, as named above, being the premises licence holder, are applying to vary a premises licence under section 41A of the Licensing Act 2003 for the premises described in this application.

Premises address

Premises contact details

Describe the proposed variations in detail and explain why you consider that they could not have an adverse effect on the promotion of any of the licensing objectives. Also include:

• whether new or increased levels of licensable activities will be taking place indoors or outdoors (outdoors may include a tent) and give examples, such as whether music will be amplified or unamplified.
• standard days and start/finish times when the activity will take place - all timings should be given in 24-hour format, e.g. 16:00 and should only include days of the week when you intend the premises to be used for the activity
• any seasonal variations to times, for example, additional days during the summer or non-standard times for activities on particular days, such as Christmas Eve.
• any changes to hours when the premises is open to the public.

What licensable activities are subject to change if this application to vary is successful?

Select all that apply.

I/We 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.