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If you wish to nominate or become a new DPS on a premises licence, you must submit an application and consent form.

Further information

Please read our Vary DPS guidance before applying as it contains important information on the application process.


Premises Licence and Club Premises Certificate Fee and Charges 2024/25

Please note that Mid Devon District Council no longer accept payment via cheque.


Apply online

To apply online, please download and complete:

Vary Designated Premises Supervisor application form(PDF)
Vary Designated Premises Supervisor application form(DOCX)
Vary Designated Premises Supervisor application form(ODT)

These files may not be suitable for users of assistive technology.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format or to request the form in the post, please email or contact us on 01884 255255.

Please return via email to After submission of your completed form, we'll contact you to confirm receipt and arrange payment with you directly.

If you submit it online we will forward it to the Police. The Consent of an individual to being specified as Premises Supervisor form must be completed separately and emailed to us at

Apply by post

If you are submitting it hard copy you will have to post your application to:

  • Licensing, Mid Devon District Council, Phoenix House, Phoenix Lane, Tiverton EX16 6PP
  • Licensing Department, Devon & Cornwall Constabulary, Launceston Police Station, Moorland Road, Launceston, PL15 7HY

You must also complete the Consent of an individual to being specified as Premises Supervisor and return the form to the licensing Team.

The application to vary a premises licence to specify an individual as designated premises supervisor under the Licensing Act 2003 asks the licensee to give a copy of the form to the existing premises supervisor. The completed form contains personal information about the proposed new DPS and sharing this information would be in breach of the Data Protection Act 1998. It is sufficient for the licensee to inform the DPS that the application has been made, without the need to share the specific details of the application. A full copy of the application form must still be sent to police. The form will be amended via regulations as soon as possible to make this clear.


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