Variation of a designated premises supervisor

Swansea Council is the data controller for the personal information you provide on this form. We are collecting this information as part of our obligation under the Licensing Act 2003. Your information will be used to help us fulfil our legal obligation and will not be used for any other purpose. We will not share your data with third parties unless we are required or permitted to do so by law.

Data protection law describes the legal basis for our processing your data as necessary for compliance with a legal obligation. For further information about how Swansea Council uses your personal data, including your rights as a data subject, please see our corporate privacy notice on our website.
1. I / We
2. (insert name of applicant)*
3. apply to vary the DPS described below under Section 37 of the Licensing Act 2003 for the premises described in Part 1 below.
4. Premises licence number*
Part 1 - Premises details
1. Please give the address of the premises where you intend to carry on the licensable activities or, if it has no address, give a detailed description (including the Ordnance Survey references).
2. Business name*
3. Label
  1. Building and street (optional)
  2. Address line 2
  3. Town or city (optional)
  4. County (optional)
  5. Postcode (optional)
4. Detailed description if no address (optional)
  You can enter up to 2000 characters
Part 2
1. Full name of proposed designated premises supervisor*
2. Nationality*
3. Place of birth*
4. Date of birth*
5. Personal licence number*
6. Full name of existing designated premises supervisor (if any) (optional)
1. Upload the consent form signed by the proposed premises supervisor
  Consent should be given using the Consent of individual to being specified as premises supervisor form which should be downloaded and completed before uploading to this application.
2. Are you able to provide the premises licence or relevant part?*
  
  Yes
  
  No
3. Please upload a copy of the premises licence or relevant part (optional)
4. Reasons why you have not included the premises licence or relevant parts (optional)
  You can enter up to 2000 characters
1. I would like this application to have immediate effect under section 38 of the Licensing Act 2003
  
  I have enclosed the premises licence or relevant part of it
  
  I have been unable to enclose the premises licence or relevant part of it
  Section 38 of the Licensing Act 2003
1. payment will be made using the online payment system on submission of this form
  
  I have uploaded the consent form signed by the proposed premises supervisor
  
  I have uploaded the premises licence or relevant part of it or explanation
  
  I have sent a copy of this application to the existing premises supervisor, if any
  
  I understand that if I do not comply with the above requirements my application will be rejected
IT IS AN OFFENCE, UNDER SECTION 158 OF THE LICENSING ACT 2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION. THOSE WHO MAKE A FALSE STATEMENT MAY BE LIABLE ON SUMMARY CONVICTION TO A FINE OF ANY AMOUNT.

IT IS AN OFFENCE UNDER SECTION 24B OF THE IMMIGRATION ACT 1971 FOR A PERSON TO WORK WHEN THEY KNOW, OR HAVE REASONABLE CAUSE TO BELIEVE, THAT THEY ARE DISQUALIFIED FROM DOING SO BY REASON OF THEIR IMMIGRATION STATUS. THOSE WHO EMPLOY AN ADULT WITHOUT LEAVE OR WHO IS SUBJECT TO CONDITIONS AS TO EMPLOYMENT WILL BE LIABLE TO A CIVIL PENALTY UNDER SECTION 15 OF THE IMMIGRATION, ASYLUM AND NATIONALITY ACT 2006 AND, PURSUANT TO SECTION 21 OF THE SAME ACT, WILL BE COMMITTING AN OFFENCE WHERE THEY DO SO IN THE KNOWLEDGE, OR WITH REASONABLE CAUSE TO BELIEVE, THAT THE EMPLOYEE IS DISQUALIFIED.
Part 3 - Signatures
1. Please read guidance note 2.
  
  Signature of applicant or applicant's solicitor or other duly authorised agent. (see note 3). If signing on behalf of the applicant please state in what capacity.
2. Signature*
3. Date*
4. Capacity*
5. For joint applicants signature of 2nd applicant, 2nd applicant's solicitor or other authorised agent (please read guidance note 4). If signing on behalf of the applicant please state in what capacity.
6. Signature (optional)
7. Date (optional)
8. Capacity (optional)
1. Contact name (where not previously given) and postal address for correspondence associated with this application.
2. Contact name (optional)
3. Label
  1. Building and street (optional)
  2. Address line 2
  3. Town or city (optional)
  4. County (optional)
  5. Postcode (optional)
4. Label
  1. Please provide either an email address or phone number below so we can contact you regarding your application.
  2. Email
  3. Telephone
Recaptcha
1. If you want to save this form, please ensure you have entered your email address above to receive the link in order to continue it later.
3. When you click 'submit' you will be taken to our payment system. Please ensure that you fully complete your bank details, progress to the confirmation of payment and click 'finish' on the last page. If we don't receive your payment we won't be able to process your application.