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Surrender of a Personal Licence - Section116 of the Licensing Act 2003

Note

The personal licence will lapse on the day the authority receives the notice of surrender

(* Required field)

Personal Details ( See guidance note 1)

First name *
Surname *

Address ( See Guidance note 2)

Postcode
hereby surrender my personal licence

Do you have a copy of the original licence?

*

Yes No
Copy of the original licence

Or, the licence is not available because

Address for correspondence

Postcode

Please confirm all the information on this form is true and accurate

Guidance Notes

1 Insert full name of licence holder
2 Insert address of licence holder
3 Give reasons why the licence is not available.

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