Notification of Interest application form Page 1 of 7 Notification of an interest in premises under section 178 of the Licensing Act 2003 Fields marked with * are required Before completing this form please read the guidance notes Notifier declaration I/We hereby give/gives notice of my/our interest in the premises identified below for the purposes of section 178 of the Licensing Act 2003* Please provide full name(s) of notifier Part 1 – Premises details Postal address of premises or, if none, Ordnance Survey map reference or description* Address line 2 Post town* Postcode* Name of applicant for, or holder of, premises licence or club applying for, or holding, club premises certificate (if known) Premises licence/Club Premises Certificate number (if known) Next Page Last updated: 30/05/2023 07:58:23
