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Licensing Authority
Mid Devon District Council

Phoenix House, Phoenix Lane
Tiverton, Devon EX16 6PP
Tel: 01884 255255

Application for a temporary event notice licence to be granted under the Licensing Act 2003. Information on the Licensing Act 2003 is available at https://www.gov.uk/temporary-events-notice

Before completing this notice please read the guidance notes . If you are completing this notice by hand please write legibly in block capitals. In all cases ensure that your answers are inside the boxes and written or typed in black ink. Use additional sheets if necessary.

This Authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes. For further information, see our fair processing notice.

We will email you a copy of the completed notice for your records. We will also email a copy to the chief officer of police Licensing Department, Devon & Cornwall Constabulary, Launceston Police Station, Moorland Road, Launceston, PL15 7HY and Mid Devon District Council, Public Health, Phoenix House, Phoenix Lane, Tiverton, Devon, EX16 6PP Tel: 01884 255255'. The licensing authority will return an copy to you as an acknowledgement of receipt.

I, the proposed premises user, hereby give notice under section 100 of the Licensing Act 2003 of my proposal to carry on a temporary activity at the premises described below.

Part 1 - The personal details of premises user (Please read note 1)

PREVIOUS NAMES (Please enter details of any previous names or maiden names, if applicable.


YOUR DATE OF BIRTH


YOUR CURRENT ADDRESS (We will use this address to correspond with you unless you complete the separate correspondence box below)


CONTACT NUMBERS


ALTERNATIVE CONTACT DETAILS FOR CORRESPONDENCE (If you complete the details below, we will use this address to correspond with you)


ALERNATIVE CONTACT NUMBERS


Part 2 - The premises

Does a premises licence or club premises certificate have effect in relation to the premises (or any part of the premises)?
If so, please enter the licence or certificate number below:


Part 3 - The licensable activities

Please state the licensable activities that you intend to carry on at the premises (Please read note 6)


Are you giving a late temporary event notice? (Please read note 7)




If the licensable activities will include the supply of alcohol, please state whether the supplies will be for consumption on or off the premises, or both (Please read note 11)

Part 4 - Personal licence holders(Please read note 12)
Do you currently hold a valid personal licence?

If you answered "Yes" to the question above please provide the details of your personal licence below:


Part 5 - Previous temporary event notices you have given (Please read note 13)
Have you previously given a temporary event notice in respect of any premises for events falling in the same calendar year as the event for which you are now giving this temporary event notice?

Have you already given a temporary event notice for the same premises in which the event period: a) ends 24 hours or less before; or b) begins 24 hours or less after the event period proposed in this notice?

Part 6 - Associates and business colleagues (Please read note 14)
Has any associate of yours given a temporary event notice for an event in the same calendar year as the event for which you are now giving a temporary event notice?

Has any associate of yours already given a temporary event notice for the same premises in which the event period: a) ends 24 hours or less before; or b) begins 24 hours or less after the event period proposed in this notice?
Has any person with whom you are in business carrying on licensable activities given a temporary event notice for an event in the same calendar year as the event for which you are now giving a temporary event notice?


Has any person with whom you are in business carrying on licensable activities already given a temporary event notice for the same premises in which the event period: a) ends 24 hours or less before; or b) begins 24 hours or less after the event period proposed in this notice?

Part 8 - Condition (Please read note 16)

It is a condition of this temporary event notice that where the relevant licensable activities described in Section 3 above include the supply of alcohol that all such supplies are made by or under the authority of the premises user.


Part 9 - Declarations (Please read note 17)

The information contained in this form is correct to the best of my knowledge and belief. I understand that it is an offence: (i) to knowingly or recklessly make a false statement in connection with this temporary event notice and that a person is liable on conviction for such an offence to a fine up to level 5 on the standard scale; and (ii) to permit an unauthorised licensable activity to be carried on at any place and that a person is liable on conviction for any such offence to a fine not exceeding £20,000, or to imprisonment for a term not exceeding six months, or to both.