Vary The Designated Premises Supervisor Application to vary a premises licence to specify an individual as designated premises supervisor under the Licensing Act 2003 Fields marked with * are required Before completing this form please read the guidance notes Applicant declaration I/We being the premises licence holder, apply to vary a premises licence to specify the individual named in this application as the premises supervisor under section 37 of the Licensing Act 2003* Please provide full name(s) of premises licence holder Premises licence number* Part 1 – Premises details Postal address of premises or, if none, Ordnance Survey map reference or description* Post town* Postcode* Telephone number at premises (if any) Description of premises * Please read guidance note 1. Next Page Last updated: 17/11/2022 13:36:46
