CAMBRIDGE CITY COUNCIL                                        
Licensing, Environmental Services, Cambridge City Council, PO Box 700, Cambridge, CB1 OJH
Tel: 01223 457899 / 457879   Email: alcent.licensing@cambridge.gov.uk

NOTICE OF APPLICATION FOR A PROVISIONAL STATEMENT (Form B)

This notice is issued in accordance with regulations made under section 160 of the Gambling Act 2005

Notice is hereby given that the persons or organisations whose details are given in the Schedule to this notice have made an application for a provisional statement in respect of the following types of premises:      	
[Specify the type of premises to which the application relates]	
	
The application relates to the following premises:
     	
[If known, give the trading name to be used at the premises and the address of the premises as given in Part 3 of the application.  If the premises have no address, then describe the premises and the location in the same way as they are described in Part 3 of the application.]	
	
The application has been made to the following licensing authority: 
     	
Postcode:      	
Website:      	
[Insert name of the licensing authority and the address of its principal office, followed by the address of its website]	
	
Information about the application is available from the licensing authority, including the arrangements for viewing the details of the application. 	
	
The following person connected with the applicant is able to give further information about the application:
     	
[This entry is optional and is to be included if the applicant wishes to provide the name, telephone number and (if available) e-mail address of a person connected with the applicant who is able to answer questions and provide further information about the application.]

Any representations under section 161 of the Gambling Act 2005 must be made no later than the following date:      
	
[Please insert last day on which representations may be made in relation to the application. The period for making representations is 28 days (inclusive) starting with the day after the day on which the application for a provisional statement was made to the licensing authority.]	

Schedule of Applicants	
The persons or organisations making the application are as follows: 	
	
Name of 1st Applicant:      	
[Give the full name of the applicant as set out in Part 2 of the application for a provisional statement]	
	
Address of 1st Applicant:
     	
Postcode:      	
[Give the full address of the applicant as set out in Part 2 of the application for a provisional statement]	
	
The number of the operating licence held by 1st Applicant is:      	
	
The 1st Applicant applied for an operating licence on      	
[Delete as appropriate.  Insert the reference number of the applicant’s operating licence (as set out in the operating licence).  Where an application for an operating licence is in the process of being made, indicate the date on which the application was made.]	
	
Name of 2nd Applicant:      	
[Give the full name of the applicant as set out in Part 2 of the application for a provisional statement]	
	
Address of 2nd Applicant:
     	
Postcode:      	
[Give the full address of the applicant as set out in Part 2 of the application for a provisional statement]	
	
The number of the operating licence held by 2nd Applicant is:      	
	
The 2nd Applicant applied for an operating licence on      	
[Delete as appropriate.  Insert the reference number of the applicant’s operating licence (as set out in the operating licence).  Where an application for an operating licence is in the process of being made, indicate the date on which the application was made.]	
	
[Where there are more than two applicants, also give the same information for the other applicants]