Request to be removed as designated premises supervisor from Milton Keynes Council

Step 2 of 3 Submit the application

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

Please attach the completed application form below.

Application form

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.
MKC collect and use information about you so that we can provide you with council services. Full details about how we use this data and the rights you have around this can be found at www.milton-keynes.gov.uk/privacy. If you have any data protection queries, please contact the Data Protection Officer at data.protection@milton-keynes.gov.uk

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 the Milton Keynes Council privacy notice (opens in new tab).