Premises Licence - Notice of Change of Name / Address Logo

  • Premises Licence - Notice of Change of Name / Address

    Under section 33 of the Licensing Act 2003, holders of Premises Licences are required to notify their relevant licensing authority if there are any changes in the name or address shown on the face of the licence (for example, if the holder moves to a different house, or if they change their name by deed poll). This form may be used to fulfill this requirement. When received, the licensing authority will reissue the Personal Licence to show the updated details.

  • Premises Licence Details (as shown on current licence)

    All fields are mandatory and must be completed

  • New Details (to be shown on reissued licence)

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  • Declaration

  • I hold a Premises Licence issued by Surrey Heath Borough Council.  In accordance with section 33 of the Licensing Act 2003, I wish to notify the licensing authority that there has been a change in the name and/or address, to the details shown in the relevant space(s) above.

    I have attached my Full Premises Licence (or a statement of the reasons why it is not practicable for me to enclose the licence) and I will proceed to the payment option upon submission of this form to make payment of the prescribed fee.

    When making payment, please select Licensing Act 2003 Misc Fees from the payment options list.

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