Notify of change of name /address for Premises Licence Holder Change of name/address of a Premises Licence holder for a Premises Licence Fields marked with * are required I wish to notify the Licensing Team at Breckland Council of* change of name of the Premises Licence Holder (PLH) for a Premises Licence, fee is £10.50 new address of the Premises Licence Holder (PLH) for a Premises Licence, Fee is £10.50 Both, fee is £10.50 Change of name PLH previous name PLH new full name Date effective from (DD/MM/YYYY) Reason for change Please upload proof of change of name (for example marriage certificate/deed poll certificate) Permitted file types: JPEG, PNG, PDF. Maximum file size: 5MB Change of address PLH Full name PLH previous address PLH contact telephone number Postcode PLH new address Postcode PLH contact telephone number Date effective from (DD/MM/YYYY) Return licence details Please return the premises licence to Licensing Team, Breckland Council, Elizabeth House, Walpole Loke, Dereham, NR19 1EE I will return the the original premises licence * Yes No If you are not able to return the premises licence, please give reasons why not Next Page Last updated: 23/11/2022 07:26:01