Application for sex establishment licence

Local Government (Miscellaneous Provisions) Act 1982

"This Authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form within the authority for the prevention and detection of fraud. It may also share this information with other bodies administering public funds solely for these purposes."

Application Type:

Grant

Renewal

Transfer

Variation

Grant Cost

£5040.00

Renew Cost

£3360.00

Transfer Cost

£1650.00

Variation Cost

£1650.00

Payment

Please note: You must provide payment for this after completing the form. You do this online. After clicking the submit button at the end of the form you will be taken to our secure online payment website. You can then make the required payment using either a credit or debit card. You will be charged a 1.9% surcharge if you pay using your credit card.

If you do not wish to pay online you cannot use this application form. In this case you must apply using the downloadable (PDF) version of the form, which is also available on our website.

To the proper officer of the North Lincolnshire Council

I/We

Title
If Other, please specify
First name(s) ^*
Surname ^*

If you need to add more than than one name please use the Add button (above) to created further input fields.

Of
(permanent address)

Prefix e.g. first floor flat.
House name/number
Street
Village/Area e.g. Scawby, Bottesford, etc.
Town
County
Post code ^*Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.

Aged (years) ^*

whose registered or principal office is situated at: ^*

and of which the full names and private addresses of the Directors or other persons responsible for its management are as follows: ^*

Are you applying for a licence for a premises or vehicle/vessel/stall? ^*

Premises

Vehicle, vessel or stall

HEREBY MAKE APPLICATION for a licence for the use of the premises situated at and known as:

HEREBY MAKE APPLICATION for a licence for the use of the vehicle, vessel or stall situated at:

State intended opening hours of business ^*

as a sex establishment, as defined in Schedule 3 of the Local Government (Miscellaneous Provisions) Act 1982.

Dated ^*

To the best of my/our knowledge the information provided in this application is correct ^*

I agree

If agreement is on behalf of a Company or Partnership, state in what capacity

Contact email address

(Note: on submitting your completed form, if you have provided a valid email address above you will automatically receive a copy of your completed form).

Notes

1) A copy of the application for the licence has been sent to the Chief Officer of Police for the area via email.

2) Any person who, in connection with this application, makes a false statement which he knows to be false in any material respect or which he does not believe to be true, shall be guilty of an offence and shall be liable on summary conviction to a fine not exceeding £10,000.

3) Notice of the application shall be placed in the Scunthorpe Evening Telegraph. This publication must be made no later than 7 days after date of application.

4) Where the application is in respect of premises, notice of the application must also be displayed on or near the premises, and in a place where it can be conveniently read by the
public.

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