Request to be removed as designated premises supervisor from Cornwall 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/we understand the information provided on this form will be held by Cornwall Council; the information given may be retained on computer or in records.
  • I/we understand that the information will be used by the Council for the specific purposes for which it was collected and any other relevant Council purposes including Government anti-fraud data-matching, especially Benefits, Council Tax, NNDR, Housing/Rents, Salaries, Employment, Pensions and Members Allowances.
  • I/we understand the information will not be exchanged or sold to any third party. Anonymised information may be used for statistical purposes. Any queries should be raised with the Data Protection Officer who is the Council's Data Controller.

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 Cornwall Council.