Application for Personal Licence
Orkney Islands Area Licensing Board
Licensing (Scotland) Act 2005 – First Application / Renewal Application
Before completing this form please read the guidance notes at the end. Answer all questions, continuing on a separate sheet(s) if necessary. All addresses provided must included post codes.
You may wish to keep a copy of the completed form for your records.
Question 1: Your personal details. If relevant, please enter details of any previous names or maiden names. Please continue on a separate sheet if necessary. Read Note 1.
Title: Mr, Mrs, Miss, Other
Surname:
Any previous surname:
Forenames:
Date and place of birth:
National Insurance Number:
Address where ordinarily resident – we will use this address to correspond with you unless you complete the separate correspondence box below.
Post town: Post code:
Telephone Numbers.
Daytime:
Evening:
Mobile:
Email address:
Address for correspondence associated with this application (if different to the address above).
Post town: Post code:
Question 2: Your licensing qualification. Read Note 2.
I hold an accredited qualification. Yes [ ] No [ ]
If you have answered Yes, please provide a copy of your qualification with your application.
Question 3: First Applications Only.
This section should only be completed if you are submitting your first application to this Licensing Board. If answering Yes to any question please provide details below.
Note: You can only hold one personal licence at a time.
Do you currently hold a personal licence? Yes [ ] No [ ]
Do you currently have any outstanding applications for a personal licence, with this or any other Licensing Board? Yes [ ] No [ ]
Has any personal licence held by you been forfeited in the last 5 years? Yes [ ] No [ ]
Licensing Board:
Licence number:
Date of issue:
Date of expiry:
Any further details:
Question 4: Renewal Only.
This section should be completed only if you are applying for a renewal of your existing licence.
Your personal licence must accompany your application for a renewal. If you are unable to send your personal licence, you must explain why you cannot do so in the box provided below.
Details of current personal licence:
Licensing Board:
Licence number:
Date of issue:
Date of expiry:
Any further details:
If you cannot provide your personal licence, provide a statement explaining why.
Other personal licence.
Note: you can only hold one personal licence at a time.
I confirm that I do not hold any other personal licences other than the one submitted for renewal. Yes [ ] No [ ]
Question 5: Checklist.
I have:
- Enclosed two photographs of myself, one of which is endorsed as a true likeness of me by a person of standing in the community. Read Note 3: Yes [ ] No [ ]
- Enclosed a copy of any licensing qualification I hold: Yes [ ] No [ ]
- Enclosed my current personal licence (renewal only): Yes [ ] No [ ]
- Made or enclosed payment of the fee for the application: Yes [ ] No [ ]
Question 6: Previous Convictions.
You must provide details below of any conviction for a relevant or foreign offence that is not considered spent under the Rehabilitation of Offenders Act 1974. Please continue on a separate sheet if necessary. Read Note 4.
If you are declaring that you have no such convictions please write “none”.
| Offence | Court | Date | Penalty |
|---|---|---|---|
Question 7: Declaration by Applicant.
The contents of this application are true to the best of my knowledge and belief.
Signature (Read Note 5):
Date:
Please note – it is an offence to make a false statement in or in connection with this application.
(Criminal Law (Consolidation) (Scotland) Act 1995 Section 44(2)(b)).
Notes.
Information on the Licensing (Scotland) Act 2005 is available on the website of the Scottish Parliament (http://www.opsi.gov.uk/legislation/scotland/acts2005/20050016.htm).
The Act and associated Regulations are available from http://www.legislation.gov.uk.
1. Change of name or address.
Section 88 of the Licensing (Scotland) Act 2005 requires that a personal licence holder must, no later than one month after any change in the licence holder’s name or address, give the Licensing Board which issues the licence notice of the change. It is an offence not to do so.
2. Licensing qualifications.
Licensing qualifications are dealt with in section 91 of the Licensing (Scotland) Act 2005. In summary, to be eligible for a personal licence, an applicant must be aged 18 or over and possess a licensing qualification, and no personal licence previously held by the applicant must have been revoked within the period of 5 years ending with the day on which the application was received by the Licensing Board.
3. Photographs.
One photograph must have on the back of it a statement by a person of standing in the community, with the words “I certify that this is a true likeness of (name of applicant)”, followed by the full name of the person endorsing the photograph. That person should also indicate in which capacity they are signing e.g. accountant, JP, etc.
4. Convictions.
Section 75 of the Act places a duty on an applicant for a personal licence to notify the Licensing Board if he or she has been convicted of any relevant or foreign offence during the time between making the application and the application being determined by the Licensing Board. Furthermore, section 82 of the Act requires personal licence holders to notify their Licensing Board of any convictions for relevant or foreign offences within one month of the licence holder being convicted.
5. Data Protection.
The information on this form may be held on an electronic public register which may be available to members of the public on request. For more information about how your data will be used, refer to the Board’s Guidance published at https://www.orkney.gov.uk/our-services/law-and-licensing/licence-applications/alcohol-licensing/. Paper copies are available on request.
Version: 2018-06-20.