LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS) ACT 1982 APPLICATION TO REGISTER A PERSON TO PRACTICE SKIN PIERCING ACTIVITIES I hereby make application under the provisions of the above Act. 1 Full name and home address 2 Contact telephone number Contact email address 3 4 Practice (delete as applicable) Acupuncture (each acupuncture practitioner will require a separate form) Tattooing Electrolysis Cosmetic Piercing Semi Permanent Skin Colouring Details of qualifications, training and 5 experience (record details on separate sheet if necessary) Details of any convictions under the 6 above Act (record details on separate sheet if necessary). Addresses of all premises within the Bath & North East Somerset area 7 where you intend to practice (record details on separate sheet if necessary). Have you previously been registered 8 in this respect in any other district? If so, where? I have paid the application fee of £137 - receipt number I have paid the maintenance fee of £13 - receipt number You may pay by phone (01225 477531) using a credit or debit card. Please note that although there will be no charge for debit cards, there will be an additional charge of 2.5 % for credit card payments. I/We declare that the information given in this application is true. Signed Date Please return the completed form to or Licensing Services, Bath & North East Somerset Council, Lewis House, Manvers Street, Bath BA1 1JG
LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS) ACT 1982 APPLICATION TO REGISTER A PERSON TO PRACTICE SKIN PIERCING ACTIVITIES I hereby make application under the provisions of the above Act. 1 Full name and home address 2 Contact telephone number 3 Contact email address 4 Practice (delete as applicable) Acupuncture (each acupuncture practitioner will require a separate form) Tattooing Electrolysis Cosmetic Piercing Semi Permanent Skin Colouring 5 Details of qualifications, training and experience (record details on separate sheet if necessary) 6 Details of any convictions under the above Act (record details on separate sheet if necessary). 7 Addresses of all premises within the Bath & North East Somerset area where you intend to practice (record details on separate sheet if necessary). 8 Have you previously been registered in this respect in any other district? If so, where? I have paid the application fee of £137 - receipt number I have paid the maintenance fee of £13 - receipt number You may pay by phone (01225 477531) using a credit or debit card. Please note that although there will be no charge for debit cards, there will be an additional charge of 2.5 % for credit card payments. I/We declare that the information given in this application is true. Signed Date Please return the completed form to or Licensing Services, Bath & North East Somerset Council, Lewis House, Manvers Street, Bath BA1 1JG
application_form_-_personal.docx