Before completing this form please read the guidance notes.
You must include a completed copy of "Consent of individual to being specified as designated premises supervisor" with this form. You will be asked to upload this as a part of this process.
You will also be required to make a payment as part of completing this form. Please have credit/debit card details ready.
By completing this form, you agree to apply to vary a premises licence to specify the individual named in this application as the premises supervisor under section 37 of the Licensing Act 2003.
