Apply for a Club Premises Certificate Declaration for a club premises certificate to be granted under the LA 2003 and application for a club premises certificate Fields marked with * are required Club Premises details Name of club* Postal address of club, if any,or, if none, ordnance survey map reference or description* Address line 2 Post town* Postcode* Telephone number (if any) Email (optional) Club declaration as to qualifying Club status The named club below makes the following declarations* 1) Where the club to which this application relates is: a registered society within the meaning of the Industrial and Provident Societies Act 1965, a registered society within the meaning of the Friendly Societies Act 1974 or a registered friendly society within the meaning of the Friendly Societies Act, the club declares that the club satisfies: Condition 1 in section 62(2) of the Licensing Act 2003 (please give below the relevant club rule number (s) ) Condition 2 in section 62(3) of the Licensing Act 2003 (please give below the relevant club rule number (s) ) Condition 4 in section 62(5) of the Licensing Act 2003 (please give below the relevant club rule number (s) ) Condition 1 relevant club rule number (s) Condition 2 relevant club rule number (s) Condition 4 relevant club rule number (s) Does the club wish to supply alcohol to members and guests? Yes No The club declares that The purchase of alcohol for the club and the supply of alcohol by the club is under the control of the members or of a committee appointed by the members Please give relevant club rule number(s), if any 2) Where the club to which this application relates is: an association organised for the social well-being and recreation of persons employed in or about coal mines, the club declares that the club satisfies Condition 1 in section 62(2) of the Licensing Act 2003 (please give below the relevant club rule number (s) ) Condition 2 in section 62(3) of the Licensing Act 2003 (please give below the relevant club rule number (s) ) Condition 1 relevant club rule number (s) Condition 2 relevant club rule number (s) Does the club wish to supply alcohol to members and guests? Yes No The club declares that it satisfies First condition in section 66(4) of the Licensing Act 2003 Please give relevant club rule number(s), if any The club declares that it satisfies Second condition in section 66(5) of the Licensing Act 2003 Please give relevant club rule number(s), if any 3) Where the club to which this application relates does not fall into the categories in 1 or 2 above, the club declares that the club satisfies: Condition 1 in section 62(2) of the Licensing Act 2003 (please give below the relevant club rule number (s) ) Condition 2 in section 62(3) of the Licensing Act 2003 (please give below the relevant club rule number (s) ) Condition 3 in section 62(4) of the Licensing Act 2003 (please answer question below and provide further details) Condition 1 relevant club rule number (s) Condition 2 relevant club rule number (s) The club’s arrangements for restricting the club’s freedom of purchase of alcohol are: a) contained in club rule number (s) b) or as follows The club’s provisions by which money or property of the club or any gain arising from the carrying on of the club is or may be applied for charitable benevolent or political purposes are: a) contained in club rule number (s) b) or as follows The arrangements for giving members information about the finances of the club are: a) contained in club rule number (s) b) or as follows Please describe details of the books of account and other records kept to ensure the accuracy of the information about finances given to members of the club or give the relevant rule number(s)* Please tick * Condition 4 in section 62(5) of the Licensing Act 2003 Condition 5 in section 62(6) of the Licensing Act 2003 The club proposes to supply alcohol to members and guests and declares that the club satisfies: additional condition 1 in section 64(2) of the Licensing Act 2003 (please give relevant club rule number (s) below, if any ) additional condition 2 in section 64(3) of the Licensing Act 2003 (please give relevant club rule number (s) below, if any ) additional condition 3 in section 64(4) of the Licensing Act 2003 (please give relevant club rule number (s) below, if any ) Condition 1 relevant club rule number (s) Condition 2 relevant club rule number (s) Condition 3 relevant club rule number (s) Please upload a copy of the club rules* Permitted file types: JPEG, PNG, PDF. Maximum file size: 5MB It is an offence, under Section 158 of the Licensing Act 2003, to make a false statement in or in connection with this application. Those who make a false statement may be liable on summary conviction to a fine of any amount I make this declaration on behalf of the club and have authority to bind the club and I understand that by checking the declaration box below it is classed as my electronic signature and is the legally binding equivalent to my handwritten signature* Name of person signing this form* Date (DD/MM/YYYY)* Capacity* Club Chairman Club Secretary Club Treasurer As a public body, we are under a duty to protect the public funds that we administer, and to this end may use the information you have provided on this form for the prevention and detection of fraud. We may also share this information with other bodies responsible for auditing or administrating public funds for these purposes. Next Page Last updated: 13/02/2023 08:15:15
