Address for correspondence associated with this application (if different to the address above) Post town Post code TELEPHONE NUMBERS Daytime Evening Mobile E-MAIL ADDRESS (if you would prefer us to correspond with you by e-mail) 2. Your licensing qualifications Read Note 1 Please tick yes Please indicate below which one of these statements applies to you: 1. I hold an accredited licensing qualification 2. I hold a certified qualification 3. I hold an equivalent qualification 4. I am a person of prescribed description If you have ticked either of statements 1, 2 or 3 please provide details of your qualification in the box below (name of qualification, date of issue, issuing body) and please enclose your qualification with your application. If you have ticked statement 4, please provide evidence that you are a person of prescribed description. 3. Previous or outstanding applications for a personal licence Note: You may only hold one personal licence at a time. Please tick Do you currently hold a personal licence? Yes No Do you currently have any outstanding applications for a personal Yes No licence, with this or any other licensing authority?
Address for correspondence associated with this application (if different to the address above) Post town Post code TELEPHONE NUMBERS Daytime Evening Mobile E-MAIL ADDRESS (if you would prefer us to correspond with you by e-mail) 2. Your licensing qualifications Read Note 1 Please tick yes Please indicate below which one of these statements applies to you: 1. I hold an accredited licensing qualification 2. I hold a certified qualification 3. I hold an equivalent qualification 4. I am a person of prescribed description If you have ticked either of statements 1, 2 or 3 please provide details of your qualification in the box below (name of qualification, date of issue, issuing body) and please enclose your qualification with your application. If you have ticked statement 4, please provide evidence that you are a person of prescribed description. 3. Previous or outstanding applications for a personal licence Note: You may only hold one personal licence at a time. Please tick 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 authority? Yes No
form-c-application-for-a-personal-licence.docx