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    Application for a provisional statement

    Use this form to apply for a provisional statement to be granted under the Licensing Act 2003.

    Please ensure you have read the guidance notes below. You should have these ready as you will need to refer back to them when completing your application:
    Provisional Statement Guidance Notes (doc 62.34kb, opens in a new window)

    The fee for this permit is £315.00 and is payable upon completion of this form.

    This form consists of 9 pages and will take approximately 20 minutes to complete. Fields marked with a * are mandatory and require completion.


    Before you start

    Please ensure you have:

  1. plans of the works to be done at the premises
  2. a valid email address to receive confirmation of payment
  3. your debit or credit card details.
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