Lisburn Online Forms - Entertainment Licence Application

Title:

First Name:

Last Name:

Maiden name:

Date of birth dd/mm/yyyy:

E-Mail:

Main telephone number:

+

Other telephone number:

+

Fax number:

+

Street Number and Name:

City or Town:

Post Code:

Country:

Are you applying as a company, business or organisation?:

YesNo

Company, business or organisation name?:

Is your business registered in the UK with Companies House?:

YesNo

Is your business registered outside the UK ?:

YesNo

Registration Number:

VAT Number:

Legal Status:

Legal Status -other:

Your position in the business:

Premises Name:

Street Number and Name:

City or Town:

Postcode:

Country:

Business telephone number:

+

Business fax:

+

Type of Application:

NewRenewalTransfer

Type of lience:

Annual
Occasional - up to 14 specific dates
Occasional - 14 unspecified dates

Company business or organisation name:

Address (if different from above):

Main telephone number:

+

(please tick all that apply):

Monday (insert hours):

Tuesday (insert hours):

Wednesday (insert hours):

Thursday (insert hours):

Friday (insert hours):

Saturday (insert hours):

Sunday (insert hours):

If outdoor site please describe the exact location:

eg. ground floor bar etc.:

Total number:

Please tick all that apply (if any):

Structural alterations or extensions
Decoration or renovation
Addition of fitments, appliances or equipment (eg. smoke machine)
No changes made

Please provide any additonal information which is required or relevant to your application (please refer to the guidance notes and licence conditions) regarding any of the above:

Fees:

I declare that:

the information that I have given is correct and true

I declare that:

I have read the licence terms and conditions and agree that, if this licence is granted, I will comply with them or any other conditions that the Council may apply to the licence

Name:

Section 1 : Applicant Details
Title:
First Name:
Last Name:
Maiden name:
Date of birth dd/mm/yyyy:
E-Mail:
Main telephone number:	+
Other telephone number:	+
Fax number:	+
Street Number and Name:
City or Town:
Post Code:
Country:
Your Business
Are you applying as a company, business or organisation?:	YesNo
If you answered NO please go to Section: 2
If you answered YES please complete the following
Company, business or organisation name?:
Is your business registered in the UK with Companies House?:	YesNo
Is your business registered outside the UK ?:	YesNo
Registration Number:
VAT Number:
Legal Status:
Legal Status -other:
Your position in the business:
Company, business. organisation address (if different from applicants address)
Premises Name:
Street Number and Name:
City or Town:
Postcode:
Country:
Business telephone number:	+
Business fax:	+
Section 2: Type of Application
Type of Application:	NewRenewalTransfer
Type of lience:	Annual Occasional - up to 14 specific dates Occasional - 14 unspecified dates
Premises or site for which licence is required
Company business or organisation name:
Address (if different from above):
Main telephone number:	+
Types of Entertainment to be provided
(please tick all that apply):	Theatrical performance Dancing, singing, music etc Circus Boxing, wrestling, judo, karate etc Billiards, pool, snooker etc Darts Other sports Machines for entertainment or amusement Equipment for playing billiards, pool, snooker etc Public outdoor musical entertainment
Days and hours when entertainment will be provided
Monday (insert hours):
Tuesday (insert hours):
Wednesday (insert hours):
Thursday (insert hours):
Friday (insert hours):
Saturday (insert hours):
Sunday (insert hours):
Description of Premises or site to be licensed
If outdoor site please describe the exact location:
Please provide a brief description of the parts of the premises to be licensed for entertainment
eg. ground floor bar etc.:
Maximum number of people who will be admitted to the premises/site at any one time
Total number:
Additional Details
If this is an application for renewal of licence, have any of the following changes been made to the premises since the previous licence was issued?
Please tick all that apply (if any):	Structural alterations or extensions Decoration or renovation Addition of fitments, appliances or equipment (eg. smoke machine) No changes made
Please provide any additonal information which is required or relevant to your application (please refer to the guidance notes and licence conditions) regarding any of the above:
Cost
Fees:
Declaration
I declare that:	the information that I have given is correct and true
I declare that:	I have read the licence terms and conditions and agree that, if this licence is granted, I will comply with them or any other conditions that the Council may apply to the licence
Name: