Premises Licence or Club Premises Certificate - Request for Replacement Licence

By completing the form you are confirming the Premises Licence/Club Premises Certificate has been lost/stolen and request a duplicate Premises Licence/Club Premises Certificate be issued.

If you are requesting a replacement Licence due to damage, please return it to:

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

Replacement Licence

I confirm that the Premises Licence/Club Premises Certificate has been:
Lost
Stolen
Please tick which licence you would like a duplicate of:
Premises Licence Certificate
Club Premises Certificate

Personal Details

Your Name *
Address line 1 *
Address line 2
Town
Postcode *
Telephone number:

Telephone number: area code ()
Contact Email Address *

Premises Details

I/We (full name(s) of premises licence holder)
Full Name of Premises
Licence Number *
Address line 1
Address line 2
Town
County
Postcode

Police Reference - Please complete to confirm you have reported the loss to the police

Please enter your police reference

By clicking submit you are confirming that the information contained in this form is correct and to the best of your knowledge and belief.

You will now be taken to the payments system, where you will be required to make a payment of £10.50 for a replacement licence