Application for a Sexual Entertainment
Venue Licence
The completed application form, any supporting
information, copy of the plans of the premises
together with the appropriate fee should be sent to
The Licensing Service
Hackney Service Centre
1 Hillman Street
London E8 1DY
FOR OFFICE USE ONLY
(Telephone: 020 8356 4970)
Receipt No.:
Date Received:
Plans Received:
Fee Received:
Please read the guidance notes which accompany this form.
This form can be used to apply for a transfer of an existing licence only.
PART 1: PREMISES DETAILS
1A).
Name of premises for which the
transfer of licence is sought
1B).
Full address of premises
1C)
Telephone Number
2A).
Maximum number of persons to
be accommodated on the
premises.
2B).
Specify the areas/parts of the
premises for which a transfer of
the licence is sought
PART 2: APPLICANT DETAILS
Please state if you are applying for a sexual entertainment venue licence
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as
a) an individual or individuals
Tick relevant box
□ please complete Question 3
b) a partnership or other
unincorporated body
□ please complete Question 4
c) a body corporate
□ please complete Question 5
3. Application from an individual / individuals
a) Full name(s) of the applicant(s)
seeking the transfer of the licence
Applicant 1:
a)
b) Date of birth for each applicant
b)
c) Permanent address of each
applicant
c)
Applicant 2:
a)
b)
c)
(Continue on separate sheet if
necessary)
4. Application from a partnership or other unincorporated body
a) Full name(s) of the applicant(s)
Applicant 1:
seeking the transfer of a licence
(all partners or, if relevant,
a)
unincorporated body name)
b)
b) Date of birth for each applicant
c)
c) Permanent address of each
applicant
(for unincorporated body answer d
below instead)
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Applicant 2:
a)
b)
c)
(Continue on separate sheet if
necessary)
d. For unincorporated body,
registered / principal office address
( in the case of an unincorpated
body, these details are provided
instead of personal address
information)
5. Application from a body corporate
a) Full name of the body corporate
seeking the transfer of a licence
b) Applicant’s permanent address or
registered / principal office
c) Please list the directors, the company secretary and/or other persons
responsible for the management below (continue on separate sheet if
necessary)
Date became
Address of permanent
Name
resident in the UK residence throughout the six
months immediately
preceding this application
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PART 3: FURTHER APPLICANT INFORMATION – to be completed by all
6. Is the applicant or any person
mentioned in 3, 4 or 5 above
concerned, financially or otherwise,
with any other business which
controls or manages sexual
entertainment venues?
If the answer is YES, give details of
the person(s) concerned, together
with details of the other businesses
and the nature/extent of the
connection.
(Continue on separate sheet if
necessary)
7a) Specify whether the applicant is the
freeholder or leaseholder etc of the
premises for which the licence is
sought.
□ FREE HOLDER
□ LEASE HOLDER
□ OTHER
(please specify)
7b) If you are the LEASE HOLDER,
give name and address details of
the landlord.
8. Is the whole of the business owned
YES*/NO*
by the applicant?
9. Please complete the details below in respect of each individual who is/will be
responsible for the day-to-day management of the premises in the absence of
the licence holder
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(continue on separate sheet if necessary)
Name
Address
Date he/she became
resident in UK
10. Has any person named in any place in this application been associated in
any way with any other application for a licence for a sexual entertainment
venue either in
A)
London Borough of Hackney
YES*/NO*
B)
Elsewhere
YES*/NO*
b) If YES, give full details:
Address of Premises
Reference
Name of Council
11. Does any person named anywhere in this application have in force a
disqualification from holding a sex establishment licence under the Local
Government (Miscellaneous Provisions) Act 1982?
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YES*/NO*
If yes, please provide details:
12. Is there any further information which you wish the Council to take into
account when considering this application? (This can include for example
any management plans or policies you operate that you wish to append, or
your experience of running a sex establishment)
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PART 4: DECLARATION / SIGNATURES
It is an offence to make a false declaration. If you have any queries or
require any clarification regarding the application process, please contact
the Licensing Service
A.
I have read the accompanying guidance notes, policy and the Council’s
Regulations, setting out the standard conditions, in respect of a sexual
entertainment venue.
B.
I enclose the required fee.
C.
I have arranged for the required public notice of the application to appear in
the local press within the next seven days
D.
I will display the required site notice regarding the application for at least 21
days from the date the application is lodged with the Council
E.
I confirm I have provided a copy of the application to the Police.
Signed
Date
Name (Printed)
Position
Signed
Date
Name (Printed)
Position
PLEASE NOTE THAT ALL THE ABOVE SECTIONS OF THE FORM
IS OPEN TO INSPECTION BY THE PRESS AND PUBLIC
This Authority is under a duty to protect the public funds it administers and,
to this end, may use and/or share the information you have provided within
the Authority, for the prevention and detection of fraud. It may also share
this information with other bodies administering public funds solely for these
purposes.
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DETAILS OF PREVIOUS CONVICTIONS
Please give full details of any previous unspent convictions in respect of any
person or body named in Questions 3,4 or 5 of this application. If necessary, use
a separate sheet and attach it to this form.
If there are no previous convictions to list, please tick the box 
(All unspent convictions must be disclosed, but see guidance below re: spent
convictions)
Name
Date of
Conviction
Date:
Offence
Sentence
(including
Suspended
sentence)
Signature:
Name
(BLOCK CAPITALS PLEASE)
THIS SECTION OF THE FORM IS NOT OPEN TO INSPECTION
BY THE PUBLIC AND OTHER PUBLIC BODIES
The Rehabilitation of Offenders Act 1974 outlines certain convictions which
become spent after a defined period - see the following guidance:
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Guidance on spent and unspent Convictions:
Sentence
Becomes spent after:
Imprisonment of between 6 months and two
and a half years
10 years
Imprisonment up to 6 months
7 years
Borstal training
7 years
A fine or other sentence not covered
otherwise in this table
5 years
Absolute discharge
6 months
Probation order, conditional discharge or
approved bind over
1 year (or until order expires, whichever is
the longer)
Detention Centre Order
3 years
Remand Home, Attendance Centre or
approved School Order
The period of the Order and a further year
after the order expires
Hospital Order under the Mental Health Act
The period of the Order and a further two
years after it expires
Cashiering, discharge with ignominy or
dismissal with disgrace from the Armed
Forces
10 years
Dismissal from Armed Forces
7 years
Detention
5 years
NOTE:
I)
a sentence of more than two and a
half years imprisonment can never
become spent
II)
if you were under 17 years of age on
the date of conviction please halve
the period shown in this column
The Licensing Service
Hackney Service Centre
1 Hillman Street
London E8 1DY
Telephone No. 020 8356 4970
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Consent of Sexual Entertainment Venue licence
holder to transfer
Section 1
Name and Address of Venue to
which application relates
Licence Number
Section 2 (to be completed by existing licence holder)
I / we …………………………………………………………………………………
(insert full name(s) of existing licence holder(s)
the licence holder(s) in respect of the above mentioned sexual
entertainment venue licence, hereby give my / our consent for the transfer
of the licence to
………………………………………………………………………………………….
(insert full name(s) of transferee
Signed ………………………………………………………………………………..
Name
(printed)……………………………………………………………………………….
Date ……………………………………………………………………………………
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