Request to be removed as designated premises supervisor from Stafford Borough Council

Step 2 of 4 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.
How we use your personal information The information that you have provided on this form will be used by Stafford Borough Council, who are the data controller, for the processing of your application and providing you with a licence. We will only share your information with/ or on The Public Register, The Home Office, other Government agencies, Council departments and Enforcement agencies and the National Fraud Initiative when necessary or where the law otherwise requires or allows us to do so. For further information, please see www.staffordbc.gov.uk/privacynotices

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 Stafford Borough Council.