Consent to be designated from Basildon Borough Council

Step 2 of 3 Submit the application

Email address

Please provide your email address, so the licensing authority can let you know if your application has been successful or not.

Email address Confirm email address

Application form

Please attach the completed application form below.

Application form

Declaration

I/we understand it is an offence, liable on conviction to a fine up to level 5 on the standard scale, under section 158 of the licensing act 2003, to make a false statement in or in connection with this application.
Basildon Borough Council is a data controller for the purposes of data protection legislation. All personal information is held and processed in accordance with this. Please refer to our privacy notices published on our website at www.basildon.gov.uk/privacy/.............. for details. Please contact us if you need the privacy notice in an alternative format. http://www.basildon.gov.uk/privacy-licensing http://www.basildon.gov.uk/privacy-environmental-health http://www.basildon.gov.uk/privacy-food-and-safety

Ticking this box indicates you have read and understood the above declaration

By continuing, you're giving the Cabinet Office permission to pass the information you're supplying to the relevant authority.

For more details on how your information is used please refer to the Government Digital Service privacy notice (opens in new tab) and Basildon Borough Council.