Vary The Designated Premises Supervisor

Application to vary a premises licence to specify an individual as designated premises supervisor under the Licensing Act 2003
Fields marked with * are required
Before completing this form please read the guidance notes
Applicant declaration
1. I/We being the premises licence holder, 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*
  Please provide full name(s) of premises licence holder
2. Premises licence number*
Part 1 – Premises details
1. Postal address of premises or, if none, Ordnance Survey map reference or description*
2. Post town*
3. Postcode*
4. Telephone number at premises (if any)
5. Description of premises *
  Please read guidance note 1.

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