Notification of Change of Address- Designated Premises Supervisor

Change of Address

Licensing Act 2003 Premises Licence- Notification of Change of Address of Desiganted Premises Supervisor.

After completing this form, please can you send your Premises Licence and Summary to:

Commercial Licensing Team
The Gateway
Gatehouse Road
Aylesbury
Buckinghamshire
HP19 8FF

Premises Details

Name of the Premises where the Licence is held *
Premises Licence Number *

Full Name of Designated Premises Supervisor

Full Name *

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Email address *

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Previous Address

Address line 1
Address line 2
Town
County
Postcode

New Address

Address line 1 *
Address line 2
Town
Postcode *

By choosing submit you are confirming that the information contained in this form is correct to the best of your knowledge and belief.
You will then be taken to the council's payment system to make your payment of £10.50.