Premises Licence Holder - Consent to Transfer

PREMISES LICENCE HOLDER - CONSENT TO TRANSFER
Name of premises licence holder (if an individual)

PrefixFirst NameLast Name
Name of premises licence holder (if an individual)

PrefixFirst NameLast Name
Name of premises licence holder (if an organisation or business)
Premises Licence Number
Address of premises to which the application relates

Name / Number

Street / Road

TownState / Province

Post Code
Full name of transferee

PrefixFirst NameLast Name
Full name of transferee

PrefixFirst NameLast Name
Business Name of transferee (if not an individual)
Transferee e-mail address
example@example.com
DECLARATION
I/We hereby give my/our consent for the transfer of the premises licence number given above to the transferee named above
Please tick to confirm consent (mandatory)*

I/We confirm
Date

DayMonthYear
Privacy Statement

Details of Surrey Heath Borough Council’s Privacy Notice can be found here
Should be Empty:

PREMISES LICENCE HOLDER - CONSENT TO TRANSFER