Request to be removed as designated premises supervisor
Required hidden Information
Queue Record Id
Contact Id
Process Record Id
Customer details
Your name
Full postal address (including postcode)
Email
Contact number
Details of premises
Name of premises
Address of premises
Premise licence holder
Are you the premise licence holder?
Yes
No
I confirm I am the holder of the Premises Licence
Can you provide the appropriate part of the licence?
Yes
No
Upload the appropriate part of the licence
Give reasons as to why you cannot provide the appropriate part of the licence
Designated premises supervisor
I am not the holder of the premises licence and hereby give to the premises licence holder, no later than 48 hours after giving notice under Section 41 (1), a copy of the above notice and given notice under Section 41(4)(b) of the Act directing the holder to send to the Licensing Authority within 14 days of receiving this notice the following (i) the Premises Licence (or the appropriate part of the licence), or (ii) if that is not practicable, a statement of the reasons for the failure to provide the licence or part of.
Can you provide the appropriate part of the premises licence?
Yes
No
Upload the appropriate part of the premises licence
Give reasons as to why you cannot provide the appropriate part of the licence
Name
Date
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