Licensing Representation form

Please be aware that this form may be viewed by the Applicant or by a representative of the Applicant. It may also be read out in public at a Licensing Hearing.
Any person may make a Representation about a relevant licence application.

Representations may be made on their behalf by a representative e.g. MP, solicitor, or a friend.

Representations are only relevant to an application if they relate to at least one of the four Licensing Objectives listed below:

The Prevention of Crime and Disorder

Public Safety

Prevention of Public Nuisance

The Protection of Children from Harm

Representations may be made at any time during a period of 28 consecutive days starting on the day after the application was given to the Licensing Authority.

In the case of a closure order issued by the Police, representations may be made during the seven days that follow relevant notice being given to the Local Authority by the Magistrates Court, starting on the day after the day the notice was received.

Once you have made your representation should you wish to withdraw it you may do so by confirming this in writing, providing you do so no later than 24 hours before any hearing, or otherwise orally at the hearing.
Fields marked with * are required
Contact Details
1. Your Name*
2. Contact Phone Number*
3. Email Address*
4. Please enter your address postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
5. Postcode:*
7. Address:
8. Address 1*
9. Address 2
10. Town*
11. County*
12. Postcode*
Application Details
1. Please provide details of the application about which you wish you make a representation
2. Name of Applicant*
3. Address of Premises*
4. Application Details*
Representation Details
1. Please provide details of your representation below. Indicate which of the Licensing Objectives your representation refers to
2. Licensing Objectives*
  
  The Prevention of Crime and Disorder
  
  Public Safety
  
  Prevention of Public Nuisance
  
  The Protection of Children from Harm
3. Details of representation*
4. If possible please suggest alterations to the application that would resolve the problem mentioned above, again paying attention to the Licensing Objectives
5. Suggestions
Documentation uploads
1. Please provide any photographic evidence you have or petitions to help with your representation
2. Document 1
3. Document 2
Once the Licensing Authority has received this form you will receive a written acknowledgement and you may be contacted to discuss the issue prior to any referral to the sub-committee hearing
1. Once the Licensing Authority has received this form, you will receive a written acknowledgement and may be contacted to discuss the issue prior to any referral to the sub-committee hearing
2. Please indicate if you consent to any notice of any hearing being sent to you by the email address you provided*
  
  Yes
  
  No
3. Please indicate if you wish to attend or be represented at any hearing*
  
  Yes
  
  No
4. I understand that by checking the declaration box it is classed as my electronic signature and is the legally binding equivalent to my handwritten signature
5. Name of person completing form*
6. If your form has been successfully submitted you will receive an auto reply of acknowledgement, if you don't receive this you will need to submit your form again
7. Privacy statement
  
  Breckland Council is collecting this information, via this form, in order to perform this service or function, and if further information is needed in order to do so, you may be contacted using the details provided.
  
  In performing this service, the Council may share your information with other organisations or departments, but only when it is satisfied that it is necessary to perform a public task, or to exercise its statutory duties to do so.
  
  The Council may also share your personal information for the purposes of the prevention, investigation, detection, or prosecution of criminal offences, but will not share your personal information, or use it for any other purpose, unless provided for by law.
  
  More detailed information about the Council's handling of your personal data can be found in our privacy policy.

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Licensing Representation form

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Licensing Representation form

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