Apply to Vary a Club Premises Certificate Application to vary a club premises certificate to be granted under the Licensing Act 2003 Before completing this form please read the guidance notes Fields marked with * are required Club application wording The named club below, applies for a club premises certificate under Section 84 of the Licensing Act 2003 for the premises named in Part 1 below.* Club Premises Certificate (CPC) number* Part 1 – Club Premises details Name of club* Please enter the postal address postcode of premises and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address. If the address isn't found, please enter address manually Postcode: Address box: Postal address of premises, if any, or if none ordnance survey map reference or description Address line 2 Post town* Postcode* Telephone number (if any) Email (optional) Non-domestic rateable value of premises* None to £4,300, fee payable is £100 £4,301 and £33,000, fee payable is £190 £33,001 and £87,000, fee payable is £315 £87,001 and £125,000, fee payable is £450 £125,001 or more, fee payable is £635 The Valuation Office Agency website can provide information on your rateable value Secretary details Name of person performing duties of a secretary to the club* Address of person performing duties of a secretary to the club* Address line 2 Post Town* Postcode* Daytime contact telephone number (if any) Email address * Next Page Last updated: 13/02/2023 08:25:07
