Request to be removed as designated premises supervisor from Basingstoke and Deane 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.

Application form

Please attach the completed application form below.

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.
  • I do not have the premises licence but have advised the premises licence holder to submit the premises licence to you within 14 days of receipt of this notice.
  • I enclose parts A and B of the premises licence for my name to be removed
  • I will forward a copy of the notice to the Premises Licence Holder and Hampshire Constabulary, Licensing Unit, Basingstoke Police Station, London Road, Basingstoke, Hants, RG21 4AD.

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