Under the Licensing Act 2003, members of the public are permitted to make representations for or against new premises licence applications, applications to vary existing premises licences and applications for the review of a premises licence.

Please make sure you have read the guidance notes about how to make a representation before completing this form.

In order for the representations to be valid they must relate to one or more of the following four licensing objectives:

• prevention of crime and disorder


• ensuring public safety


• prevention of public nuisance


• protection of children from harm

Please note that it is an offence to knowingly or recklessly make a false statement in connection with an application and the maximum fine for which a person is liable on summary conviction for the offence is £5000.
Items marked with an asterisk (*) must be completed.