Notification of an interest in premises under section 178 of the Licensing Act 2003

SSDC - Privacy Statement on Handling of Personal Information

I/we (insert name(s) of notifier) *
hereby give/gives notice of my/our interest in the premises identified below for the purposes of section 178 of the Licensing Act 2003

Part 1 - Premises Details

Name of premises *
Do you know the address of the premises? *
Telephone number (if any):
Premises licence number (if known)
Name of applicant for, or holder of, premises licence or club applying for, or holding, club premises certificate (if known):