ࡱ> e R%bjbj:: 4Xg\Xg\R<POtJOLOLOLOLOLOLO$?QSpOpOO JOJO^JDVM0fhK&6OO0OKTTLVMTVMihT%pOpOjOT> :   Licensing (Scotland) Act 2005, sections 33, 34 and 35 APPLICATION FOR TRANSFER OF PREMISES LICENCE If you are completing this form by hand, please write legibly in block capitals using ink.  Is this application made in terms of Section 33 of the Licensing (Scotland) Act 2005? 34.00 YES/NO Is this application made in terms of Section 34 of the Licensing (Scotland) Act 2005? 21.00 YES/NO Is the applicant applying for a variation with the transfer application YES/NO APPLICANT INFORMATION Question 1 Please provide the name, address, postcode, date and place of birth, and contact telephone number of the current Licensee.  Question 2 Where the application is made by the current licence holder, applicant is the person(s) into whose name the licence is to be transferred. 2(a) Where the applicant is an individual, provide full name, date and place of birth, home address including postcode, telephone number and e-mail address.  2(b) Where the applicant is a partnership, please provide full name, and postal address of partnership.  2(c) Where the applicant is a company, please provide name, registered office and company registration number and a contact address.  2(d) Where the applicant is a club or other body, please provide full name, and postal address of club or other body.  2(e) Where the applicant is a partnership, company, club or other body, please provide the names, dates of birth and home addresses of the connected persons. * * Connected person is defined in Section 147(3) of the Licensing (Scotland) Act 2005. Question 3 Previous applications 3 Has the applicant been refused a premises licence under section 23 of the Licensing (Scotland) Act 2005 in respect of the same premises? NO/YES If YES provide full details  Question 4 Previous convictions Has the applicant or any connected person ever been convicted of a relevant or foreign offence? In addition to any convictions held by the applicant at the time of application, applicants should also familiarise themselves with the contents of section 24(1) of the Licensing (Scotland) Act 2005 in respect of any convictions for relevant or foreign offences which they may receive during the period beginning with the making of the premises licence application ending with determination of the application. * If YES- provide full details For the purpose of this Act, a conviction for a relevant offence or foreign offence is to be disregarded if it is spent for the purpose of the rehabilitation of Offenders Act 1974 Name & position (if applicable) Date of conviction or sentence Court Offence Penalty   Question 5 Has the licence holder: - Died Become incapacitated Become Insolvent Been dissolved Transferred the business in the premises to another person Question 6 Please provide full name, address, postcode and licence number of the premises  If you do not wish to apply for a variation of the licence with the transfer application, please go to page 9 and date and sign the application form. If you do wish to apply for a variation of the licence with the transfer application, please complete the rest of the application form MINOR VARIATIONS Question 7 7(a) Do you consider the proposed variation to be a minor variation YES/NO (If YES, please answer the rest of question 7. If NO please go to question 8) 7(b) Do you propose a variation to the layout plan which is not inconsistent with the operating plan for the Premises? YES/NO (if YES, please give details of the proposed variation below)  7(c) Do you propose to restrict the terms on which children and young persons are admitted to the premises? YES/NO (if YES please give details of the proposed variation below)  7(d) Do you propose to vary the information contained in the licence relating to the premises manager, including a variation to substitute a new premises manager? YES/NO (is YES, please go to question 5 below) 7(e) Do you propose any other variation as prescribed by Section 29(6) (d) of the 2005 Act? YES/NO (if YES, please give details of the proposed variation below)  OTHER VARIATIONS Question 8 8(a) Do you propose a variation to the conditions to which the license is subject (other than those to which the licence is subject by virtue of Section 27(1)? YES/NO (if YES, please give details of the proposed variation below)  8(b) Do you propose to vary any of the information contained in the operating plan contained in the licence? YES/NO (if YES, please give details of the proposed variation below)  8(c) Do you propose a variation to the layout plan contained in the licence? YES/NO (if YES, please give details of the proposed variation below)  8(d) Do you propose to vary any other information contained or referred to in the licence, including an addition, deletion or other information? YES/NO (if YES, please give details of the proposed variation below)  VARIATION TO SUBSTITUTE NEW PREMISES MANAGER Question 9 Please provide details below of the name, address and personal licence number of the Existing Premises Manager.  Proposed Premises Manager 9(a) Name and telephone number  9 (b) Date and place of birth  9(c) Contact address, including postcode  9(e) Personal Licence Date of IssueName of Licensing Board issuing Reference no. of personal licence   9(f) Is the variation to take effect during the application period? YES/NO* If the answer to the above question is NO, please provide below the date from which the variation is to take effect.  DECLARATION BY AGENT ON BEHALF OF APPLICANT If signing on behalf of the applicant please state in what capacity. The contents of this Application are true to the best of my knowledge and belief. Signature * (see note below) Date: Capacity: Telephone number and email address of signatory .. I have enclosed the relevant documents with this application please tick the relevant boxesPremises Licence Operating Plan** Layout Plans ** Data Protection Act 1988 The information you have supplied on this form will be used for the purpose for which you have provided it and any relevant procedures following from this. A full privacy notice, which provides information about your rights under data protection legislation and details about what will happen to your personal data, is attached for your information ** Where the proposed variation affects the current layout plan, please submit 7 sets of plans showing the proposed new layout of the premises. Where the proposed variation affects the current operating plan, please submit an operating plan including the proposed variations. 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