Application for the registration of premises

Local Government (Miscellaneous Provisions) Act 1982 as amended by Section 120 of the Local Government Act 2003

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Your application

Please let us know if this is a new application or a variation(Required)

New application

Variation - this only needs to be used to add additional procedures to your premises licence. There is no longer a requirement to list employees on your licence

Existing licence number(Required)

Description of the variation(Required)

To carry on the practice of acupuncture, business of tattooing, business of cosmetic piercing, business of electrolysis, business of semi-permanent skin colouring.

I/We hereby make application under the provisions of the above Acts for registration to carry on the practice/business of(Required)

(please tick boxes as applicable)

Acupuncture - under Section 14

Tattooing - under Section 15

Semi-permanent skin colouring - under Section 15

Cosmetic body and ear piercing - under Section 15

Ear piercing only - under Section 15

Electrolysis - under Section 15

Document upload

Please upload a copy of your electrical certificate(Required)

Max. file size: 50 MB.

Please upload a copy of your public liability insurance(Required)

Max. file size: 50 MB.

Please upload a copy of your clinical waste contract(Required)

Max. file size: 50 MB.

Please upload a copy of your consent form(Required)

Max. file size: 50 MB.

Please upload a copy of your after-care form(Required)

Max. file size: 50 MB.

Please upload a copy of your plan of premises(Required)

Max. file size: 50 MB.

Please upload any relevant training certificates

Drop files here or

Max. file size: 50 MB.

Premises details

Name of premises(Required)

Postcode

Search Postcode

address

Address(Required)

House name/House No./Flat no Address line 1 Address line 2 City Postcode

Email address(Required)

Enter Email Confirm Email

Contact telephone number(Required)

Application details

Have any of the persons specified in the application been registered in this respect with any other Local Authorities?(Required)

Yes

No

Please tell us which authorities(Required)

Has any person specified in this application been convicted of any offence under the Acts?(Required)

Yes

No

What are/will be, the normal hours of trading at the premises?(Required)

Brief description of the premises and number, location and use of rooms(Required)

Please also provide plan showing location of room(s)

Plan showing location of room(s)(Required)

Max. file size: 50 MB.

What arrangements are there for cleansing the premises, fittings and equipment?(Required)

What arrangements are there for sterilisation of instruments?(Required)

If only disposable pre-sterilised items used, give description including type and make.

What training has been received for dealing with potentially harmful chemicals, needles, body fluids and hazardous waste?(Required)

Please list the artists working at the premises(Required)

Please provide particulars of relevant qualifications and details of Certificate(s)(Required)

Note - Original certificates may be required for inspection when routine Health and Safety Inspections are carried out.

Applicant details

Name(Required)

Prefix First Last

Date of birth(Required)

Postcode

Search Postcode

address

Address(Required)

House name/House No./Flat no Address line 1 Address line 2 City Postcode

Email address(Required)

Enter Email Confirm Email

Contact telephone number(Required)

Declaration(Required)

I certify that the particulars included in this application are correct for the registration applied for.

Declaration(Required)

I hereby confirm the information provided in this document is true and accurate to the best of my knowledge and belief.

SCP Reference

SCP Request ID

SCP Request Status

SCP Request Message

SCP Payment Info

Staff ID

Date