Application for a premises licence under the Gambling Act 2005

Where the application is—

• In respect of a vessel, or
• To convert an authorisation granted under the Betting, Gaming and Lotteries Act 1963 or the Gaming Act 1968, the application should be made on the relevant form for that type of premises or application.

(* Required field)

Part 1 – Type of premises licence applied for
  1. *







Do you hold a provisional statement in respect of the premises?
  1. *
       
If the answer is “yes”, please give the unique reference number for the provisional statement (as set out at the top of the first page of the statement):

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