Application form for grant, renewal or transfer of sex establishment licence pursuant to Schedule 3, Local Government (Miscellaneous Provisions) Act 1982 for use of premises as a sexual entertainment venue.

IMPORTANT NOTES

(1)	All questions must be answered, save where otherwise stated. If relevant questions are not answered, the application will be deemed incomplete and returned to the Applicant. 
(2)	Any person who, in connection with an application for a grant, renewal or transfer of a sex establishment licence makes a false statement which he knows to be false in any material respect or which he does not believe to be true, is guilty of an offence and liable on summary conviction to a fine not exceeding £20,000.
(3)	Please send the completed application form to Licensing, Refuse and Environment Service, Cambridge City Council, PO Box 700, Cambridge, CB1 0JH.

A.	THE APPLICANT

Question 1: 

Is the Applicant:

a.	An individual

b.	A company or other corporate body 

c.	A partnership or other unincorporated body. 

If the applicant is an individual, answer question 2.
If the applicant is a company or other corporate body, answer questions 3 and 4.
If the applicant is a partnership or other unincorporated body, answer question 5.

Question 2: 
Answer only where the applicant is an individual

(1)	What is the full name of the Applicant? 

(2)	Has the Applicant ever been known by a different name? If so, state the Applicant’s former name.

Go to question 5

Question 3: 
Answer only where the Applicant is a company or other corporate body.

(1)	(1) What is the name of the Applicant?
(2)	
(3)	(2) Where is the Applicant registered?
(4)	
(5)	(3) What is the registered number of the Applicant?
(6)	
(7)	(4) When was the Applicant registered?
(8)	
(9)	(5) Has the Applicant previously been known by any other name and if so, what name?
(10)	
(11)	(6) Has the Applicant:
•	Ever been convicted of a criminal offence?                Yes              No 

•	Has the Applicant ever had a grant or renewal of a 
sex establishment licence refused or a sex 
establishment licence revoked?			Yes                No

•	Ever been served with a winding up petition?             Yes               No
If the answer to any of these questions is Yes, provide full details. 

(7)	What are the names of the Applicant’s Directors and Company Secretary.

(8)	Are there persons responsible for the management of the Applicant other than the Directors and the Company Secretary? If so, state their names.

(9)	State the names of all persons with a shareholding greater than 10% in the Applicant.

(10)	Is the Applicant a wholly owned subsidiary of another company or corporate body? If so state the name, place of registration and identity of its Directors and Company Secretary. 

Go to question 5

Question 4: 
Answer only where the applicant is a partnership or other unincorporated body:
(1)	 What is the name of the Applicant?

(2)	What are the names of the Applicant’s partners?

(3)	Are there persons responsible for the management of the Applicant other than the partners? If so, state their names.

(4)	Has the Applicant ever had a grant or renewal of a sex establishment licence refused or a sex establishment licence revoked?                  Yes      No
If the answer is Yes, provide full details. 

Go to question 5

 Question 5:

Does the Applicant have a trading name different from that given in answer to questions 2, 3or 4 above? If so, state the trading name.

Question 6: 
What is the Applicant’s trading address?

Question 7:
Will the business for which a licence is sought be carried on for the benefit of a person other than the Applicant? Yes        □                No              □

If the answer is Yes, state the name of such person(s). If such person(s) are a company or other corporate body state their place of registration and registered number, and the identity of all Directors, the Company Secretary, and those with a greater than 10% shareholding.

Question 8: 
Does the Applicant operate any other sex establishments, whether licensed or not? If so, state the name, address and type of sex establishment (e.g. sex cinema, sex shop, sexual entertainment venue) of each.

Question 9:
For each of the individuals named in the answers to Questions 2, 3, 4 and 7, please confirm that the form at Annex A to this application has been completed and submitted as part of this application. Yes         No

B.	THE PREMISES, VEHICLE, VESSEL OR STALL

Question 10:

Is this application in respect of:

a)	Premises 		□
b)	Vehicle		□	
c)	Vessel			□
d)	Stall			□

Question 11:
Answer only where the application is for a vehicle, vessel or stall
Where is it proposed to use the vehicle, vessel or stall?

Question 12:
Answer only where the application is for a premises
What is the full address of the premises for which a licence is sought?

Question 13:
(a)	Is the whole of the premises to be used as a sex establishment?

(b)	If not, state the use of the remainder of the premises.

(c)	State the names of those who are responsible for managing the remainder of the premises.

Question 14:
(a)	State the nature of the Applicant’s interest in the premises, vehicle, vessel or stall, e.g. owner, lessee, sub-lessee.

(b)	If the Applicant is a lessee or sub-lessee, state:
(i)	the name and address of the landlord;

(ii)	the name and address of the superior landlord (if any);

(iii)	the amount of the annual rental;

(iv)	the length of the unexpired term

(v)	the length of notice required to terminate the tenancy.

Question 15:
(a) State the current use of the premises. 

(b) Is there a planning permission for the use of the premises, vehicle, vessel or stall as a sex establishment?  Yes  □    No □

(c) If so, state the date of the planning permission.

(d) If not, state whether and why the use as a sex establishment is lawful, e.g. because there is a certificate of lawful use, giving full details.

Question 16:
(a)	Are the premises, vehicle, vessel or stall licensed under any other Act, e.g. the Licensing Act 2003? Provide full details including the name of any Designated Premises Supervisor.

(b)	Does the Applicant intend to obtain a licence under any other Act or to apply to vary any existing licence under any other Act?

(c)	Does the Applicant intend to operate the sex establishment in conjunction with any other licence? If so, provide full details.

Question 17:
(a)	Is each customer access to the premises, vehicle, vessel or stall:
•	Directly from the street or a public thoroughfare? 		□
•	From other premises? 					□
If from other premises, provide full details.

(b)	Is each customer access from the street to be supervised at all times the premises are open to the public? Yes □ No □
If the answer is No give full details of proposed door control and supervision.

(c)	State whether all door supervisors are to be licensed with the Security Industry Authority. 
Yes □   No □

Question 18:
Are the premises, vehicle, vessel or stall so constructed or adapted and laid out as to permit access to, from and within the premises (including WC facilities) for members of the public who are disabled? Yes □ No□
If the answer is No, state the Applicant’s proposals for affording such access.

Question 19:
(a) Are the premises, vehicle, vessel or stall being used as a sex establishment at the date of this application? Yes □ No □
(b) If the answer is yes, state the name and address of the person or body now operating the business.

C.	THE BUSINESS

Question 20:
Under what name will the business be known?

Question 21:
Has the Applicant entered into any agreement (whether written or oral) in connection with the business, other than a tenancy agreement or lease, for example, a management agreement, partnership agreement or profit share arrangement? If so, provide full details together with a copy of any such agreement.

Question 22:
Give the name and addresses of any lenders, mortgagees or others providing finance with the full terms of such agreements.

D.	MANAGEMENT OF THE BUSINESS

Question 23:
(a)	State the identity of the person who will be responsible for the day to day management of the business at the premises, vehicle, vessel or stall (“the Manager”).

(b)	Confirm that the Manager will be based at the premises, vehicle, vessel or stall and that management of the business there will be his/her sole and exclusive occupation. 

(c)	Which person(s) will be responsible for the day to day management of the business in the absence of the Manager (“the Relief Manager(s)”).

(d)	Confirm that the Relief Manager(s) or one of them will be based at the premises full-time in the absence of the Manager.

(e)	For each of the Manager and Relief Manager(s), confirm that the form at Annex A to this application has been completed and submitted as part of this application. 
Yes □        No □

Question 24:
This question need not be answered in the case of renewals 
Give details of the times during which it is proposed to open the business.

Days of the week

Hours of the day

Question 25:
State proposals in respect of exterior signage and advertising, including the nature, content and size of such signage, and any images to be used.
Please note that a plan of the exterior showing such signage and advertising is required to be submitted with this application.

Question 26:
(1)	What means are to be taken to prevent the interior of the premises being visible to passers-by?

(2)	What, if any, window displays are to be exhibited? Please indicate the size and nature of any intended display.

Question 27:
State any proposals for solicitation of business in public areas, e.g. through fliers, business cards, billboard advertising, personal solicitation or advertising on motor vehicles.

Question 28:
State what age restrictions are to be applied in respect of admissions, and how are these to be enforced. 

In answering, state what forms of identity will be accepted and whether it is proposed to use electronic identification systems. For sex shops provide details of arrangements for preventing proxy sales.

Question 29:
State the arrangements for CCTV and for retention of recordings.

In answering, state whether all public areas are to be covered by CCTV at all times the business is open and whether the feed from all cameras will be recorded.

Question 30:

(1)State whether the proposal is for full nudity. Yes □  No □

(2) Give full details of the nature of the entertainment, e.g. lap-dancing, pole dancing, stage strip-tease.

(3 ) State what if any separation between performers and audience is proposed, e.g. performers on stage, 1 metre, no contact or full contact.

(4)	State whether arrangements are proposed for private booths or areas. If so, provide full details, including proposals for supervision of such areas.

Question 31:
This question need not be answered in the case of renewals

(1)	State proposals for preventing nuisance to residents and businesses in the vicinity.

(2)	State proposals for promoting public safety

(3)	State proposals for preventing crime or disorder

(4)	State proposals for protecting children from harm

(5)	Set out the Applicant’s system for checking the age and right to work in the UK for all employees.

(6)	Set out the system for training all staff in the Code of Practice for performers, and for monitoring and enforcing compliance. 

Note, the Code of Practice must be attached to this form.
(7)	Set out the system for notifying customers of the Rules for Customers, and for monitoring and enforcing compliance.
 
Note, the Rules for Customers must be attached to this form. 
(8)	Set out the system for monitoring compliance with the venue’s Policy for Welfare of Performers. 

Note, the Policy for Welfare of Performers must be attached to this form. 

Question 32:
Set out any further information which you wish the authority to take into account.

Include here any proposed conditions (you may attach a schedule of such conditions) or any reason relied upon to provide an exception to the authority’s Sex Establishment Licensing Policy or standard conditions.

Question 33: 
Is there any information on this form which you do not wish to be seen by members of the public? If so, state which information and the reasons why you do not wish it to be seen.

E. APPLICANT CONTACT DETAILS

Please give the contact details which you would like used for the purposes of this application.

Name:

Organisation

Address

Telephone Number

Mobile Number

Fax Number

E-mail address

F. SIGNATURE AND DECLARATION

The following declaration must be signed in all cases:

a.	If the Applicant is an individual, by that individual;
b.	If the Applicant is a partnership, by all individuals who are partners;
c.	If the Applicant is a company, by a director or the company secretary;
d.	In any other case, by a duly authorised officer of the Applicant.

Should the information provided in relation to this application form cease to be correct, or if there are any changes in the information provided in the application form between the date the application was submitted and the date it is determined, the Applicant must advise the licensing authority immediately. Failure to do so may result in any licence issued being revoked.

I / we certify to the best of my / our knowledge and belief that the information given in this application is complete and correct in every respect.

I / we agree to notify Cambridge City Council should any of the information given in this application change.

Name

Position in organisation

Date

Signature

This application should be completed in full and returned to Licensing, Refuse and Environment Service, Cambridge City Council, Po Box 700, Cambridge CB1 2BY

ANNEX A

Information on individuals named in answers to questions 2, 3, 4, 7 and 23

Note, for each individual, the applicant must supply 4 passport sized photographs which must be dated, bear the name in block capitals of the person identified in the photograph printed on the back and signed by the person making the declaration. 

1. Name

2. Former name (if any)

3. Position in relation to Applicant (e.g. Director, Partner, Manager)

4. Date of birth

5. Gender: Male / Female

6. Permanent residential address

7. If resident at this address for less than 3 years, state previous address.

8. Have you been resident in the United Kingdom for more than six months prior to the date of the application?

9. Have you ever been disqualified from holding a sex establishment licence under Schedule 3 paragraph 17 of the Local Government (Miscellaneous Provisions) Act 1982?

If so, give full details.

10. Have you ever been involved in the management of a business, whether as proprietor, director, company secretary, partner, manager, supervisor or otherwise which has had any of the following types of licence refused, refused on renewal, reviewed or revoked? 
•	Sex establishment licence.
•	Licence for the sale or supply of alcohol.
•	Licence for the provision of entertainment, whether sexual or otherwise.
•	Personal licence under the Licensing Act 2003.

If so, provide full details.

11. Have you ever been convicted of a criminal offence, whether in the United Kingdom or elsewhere? 

If so, provide details of the date, convicting court, offence and penalty imposed.

12. To your knowledge are you currently the subject of any criminal investigation? 
If so, provide full details.

13. Have you ever had any civil legal action taken against you?
If so, provide full details. 

14. Have you ever been declared bankrupt or entered into an arrangement with creditors or an Individual Voluntary Arrangement?
If so, provide full details.

15. Have you ever been disqualified from acting as a company director? 
If so, provide full details.

16. Is there any other information which you believe the licensing authority would reasonably expect notice of, or you would like the licensing authority to take into account when considering the information you have supplied?
If so, provide full details. 

17. Is there any information in this Annex which you do not wish to be seen by members of the public? If so, state which information and the reasons why you do not wish it to be seen.

I DECLARE THAT THE INFORMATION ON THIS FORM IS TRUE AND COMPLETE. 

Signed

Dated

ANNEX B

Documents to be accompanied with the application:

1.	A site scale plan (1:1250). 					Yes □	No □
2.	Drawings showing the front elevation as existing. 		Yes □	No □
3.	Drawings showing the front elevation as proposed
Including proposed signage, advertising and 
window display 						Yes □	No □
Scale layout plan of premises. 				Yes □	No □
Note, the requirements of the layout plan are set out 
below.
4.	Planning permission 						Yes □	No □
5.	Certificate of lawful use or development 			Yes □	No □
6.	If the Applicant is a company, copies of the Memorandum 
	and Articles of Association of the Company. 			Yes □	No □
7.	If the Applicant is a partnership, a certified copy of the 
Partnership Deed. 						Yes □	No □
8.	A set of accounts for the trading year immediately 
	preceding the application. 		  			Yes □	No □
	Note, the requirements for the accounts are set out
	below.
9.	A copy of any of other licences for the premises, vehicle,
vessel or stall. 						Yes □	No □
10.	Code of Practice for Performers. 				Yes □	No □
11.	Rules for Customers 						Yes □	No □
12.	Policy for Welfare of Performers 				Yes □	No □
13.	Copies of photographs of all individuals completing
	the form at Annex A. 						Yes □	No □
14. The fee (currently £4717)					Yes □	No □

Requirements for layout plan

The layout plan must show:
(1)	The layout of the premises including, e.g., stage, bars, cloakroom, WCs, performance area, dressing rooms. 
(2)	The extent of the boundary of the premises outlined in red.
(3)	The extent of the public areas outlined in blue.
(4)	All means of ingress and egress and a description of the place from which entry is made or to which the exit leads.
(5)	Uses of different areas in the premises, e.g. performance areas, reception.
(6)	Structures or objects (including furniture) which may impact on the ability of individuals to use exits or escape routes without impediment.
(7)	Location of points of access to and egress from the premises.
(8)	Any parts used in common with other premises. 
(9)	Position of CCTV cameras.
(10)	Where the premises includes a stage or raised area, the location and height of each stage or area relative to the floor.
(11)	Where the premises includes any steps, stairs, elevators or lifts, the location of the same.
(12)	The location of any public conveniences, including disabled WCs.
(13)	The position of any ramps, lifts or other facilities for the benefit of disabled people.
(14)	Any level changes at the entrance to or within the premises, which may be inaccessible to disabled people.
(15)	The location and type of any fire safety and any other safety equipment.
(16)	The location of any kitchen on the premises.

Requirements for accounts

Where the Applicant is a company, other corporate body, partnership or other unincorporated body, the Applicant should provide its full company or partnership accounts as the case may be. Where the applicant is an individual, the Applicant should provide a set of accounts for the business itself. The Council does not require such accounts to be audited unless the Applicant is otherwise required to prepare audited accounts. 

Documents evidencing public notice and service

1.	Complete copy of newspaper circulating 
in the area of the authority, containing advertisement
of this application. (Photocopies will not be accepted)	Yes □	No □
2.	Copy of notice of application displayed on or near 
the premises. 						Yes □	No □
3.	Copy of affidavit or statutory declaration that notice 
has been displayed as required by Schedule 3 paragraph
10(10) Local Government (Miscellaneous Provisions)
Act 1982. 							Yes □	No □
4.	Evidence of service of this application form and all
enclosures upon Chief Officer of Police at Parkside Police 
Station, Cambridge CB1 1JG within 7 days after the date 
of this application. 					Yes □	No □

M/licence/sex establishments/SEV application form june 2011.doc