Interim authority notice under the Licensing Act 2003

PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST

Before completing this form please read the guidance notes at the end of the form.
If you are completing this form by hand please write legibly in block capitals. In all cases ensure that your answers are inside the boxes and written in black ink. Use additional sheets if necessary.

You may wish to keep a copy of the completed form for your records.

Our full environmental health privacy policy is available at https://www.cambridge.gov.uk/media/6335/environmental-health-privacy-notice.pdf   

I/We	     	
         (Insert name of applicant)
give this interim authority notice under section 47 of the Licensing Act 2003 for the premises described in Part 1 below

Premises licence number (if known)
     	

Part 1 – Premises details
Postal address of premises or, if none, ordnance survey map reference or description
     	
Post town	     	Post code	     	
Telephone number (if any)	     	
E-mail address (optional)	     	

Part 2 – Notice giver details

In what capacity are you giving the interim authority notice?
See section 47 of licensing Act 2003
                          Please tick yes	
a)	I am an individual with a legal interest in the premises as freeholder or leaseholder		please complete section (A)	
b)	I am a person other than an individual with a legal interest in the premises as freeholder or leaseholder			
	i.	as a limited company/limited liability partnership		please complete section (B)	
	ii.	as a partnership (other than limited liability)		please complete section (B)	
	iii.	as an unincorporated association or		please complete section (B)	
	iv.	other (for example a statutory corporation)		please complete section (B)	
c)	I am a personal representative for the former premises licence holder who has died		please complete section (B)	
d)	I have power of attorney which is registered for the former premises licence holder who has become mentally incapable		please complete section (B)	
e)

f)	I am the insolvency practitioner for the former premises licence holder who is insolvent
I am applying as the former premises licence holder is no longer entitled to work in the UK.	

	please complete section (B)

please complete section (B)	

Date of lapsing of licence

On what date (as applicable)	Day	
Month	
Year	

•	did the former premises licence holder die?	 	
 	
 	
 	
 	
 	
 	
 	

•	was the power of attorney registered under section 6 of the Enduring Powers of Attorney Act 1985?	 	
 	
 	
 	
 	
 	
 	
 	

•	did the former holder become insolvent?	 	
 	
 	
 	
 	
 	
 	
 	

•	did the former holder’s immigration status expire?	 	
 	
 	
 	
 	
 	
 	
 	

(A) DETAILS OF INDIVIDUAL NOTICE GIVERS (fill in as applicable)

Mr	

	Mrs	

	Miss	

	Ms	

	Other Title (for example, Rev)	     	

Surname
     	First names
     	
Date of birth                                  I am 18 years old or over		Please tick yes if you are	
Nationality                                  			
Current residential address if different from premises address	     	
Post Town	     	Postcode	     	
Daytime contact telephone number	     	
E-mail address (optional)	     	
Where applicable (if demonstrating a right to work via the Home Office online right to work checking service), the 9-digit ‘share code’ provided to the applicant by that service (please see note 2 for information)
          	

DETAILS OF SECOND INDIVIDUAL NOTICE GIVER (IF APPLICABLE)

Mr	

	Mrs	

	Miss	

	Ms	

	Other Title (for example, Rev)	     	

Surname
     	First names
     	
			
Date of birth                                  I am 18 years old or over		Please tick yes if you are	
Nationality                                  			
Current residential address if different from premises address	     	
Post Town	     	Postcode	     	
Daytime contact telephone number	     	
E-mail address (optional)	     	
Where applicable (if demonstrating a right to work via the Home Office online right to work checking service), the 9-digit ‘share code’ provided to the applicant by that service (please see note 2 for information)
          	

(B) NON-INDIVIDUAL NOTICE GIVER

Please provide name and registered address of applicant in full. Where appropriate please give any registered number. In the case of a partnership or other joint venture (other than a body corporate), please give the name and address of each party concerned

Name
     	
Address
     	
Registered number (where applicable)
     	
Description of applicant (for example, partnership, company, unincorporated association etc.)
     	
Telephone number (if any) 
     	
E-mail address (optional)
     	

PART 3
	Yes (please tick)	
Has an interim authority notice previously been given relating to this premises and the former premises licence holder?		
If not when do you want the variation to take effect from	Day	
Month	
Year	

 	
 	
 	
 	
 	
 	
 	
 	

Has there been an application to transfer the premises licence under section 50 of the Licensing Act 2003?		

Please tick yes	
	I have made or enclosed payment of the fee

	I have sent a copy of this form to the chief officer of police for the area in which the premises is situated

I have sent a copy of this form to Home Office Immigration Enforcement	

	
	I have notified the designated premises supervisor (if different from the premises licence holder), if any

I confirm that I am entitled to work in the United Kingdom (see guidance note 2)

	

	I understand that if I do not comply with the above requirements my application will be rejected		

THIS NOTICE WILL LAPSE AT THE END OF THE 28 PERIOD AFTER THE LAPSING OF THE PREMISES LICENCE UNLESS A COPY OF THE NOTICE HAS BEEN GIVEN TO THE CHIEF OFFICER OF POLICE FOR THE POLICE AREA OR EACH POLICE AREA IN WHICH THE PREMISES IS SITUATED; AND A COPY HAS BEEN SENT TO HOME OFFICE IMMIGRATION ENFORCMENT.

IT IS AN OFFENCE, UNDER SECTION 158 OF THE LICENSING ACT 2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION. THOSE WHO MAKE A FALSE STATEMENT MAY BE LIABLE ON SUMMARY CONVICTION TO A FINE OF ANY AMOUNT.  

IT IS AN OFFENCE UNDER SECTION 24B OF THE IMMIGRATION ACT 1971 FOR A PERSON TO WORK WHEN THEY KNOW, OR HAVE REASONABLE CAUSE TO BELIEVE, THAT THEY ARE DISQUALIFIED FROM DOING SO BY REASON OF THEIR IMMIGRATION STATUS. THOSE WHO EMPLOY AN ADULT WITHOUT LEAVE OR WHO IS SUBJECT TO CONDITIONS AS TO EMPLOYMENT WILL BE LIABLE TO A CIVIL PENALTY UNDER SECTION 15 OF THE IMMIGRATION, ASYLUM AND NATIONALITY ACT 2006 AND, PURSUANT TO SECTION 21 OF THE SAME ACT, WILL BE COMMITTING AN OFFENCE WHERE THEY DO SO IN THE KNOWLEDGE, OR WITH REASONABLE CAUSE TO BELIEVE, THAT THE EMPLOYEE IS DISQUALIFIED. 

Part 4 – Signatures   (please read guidance note1)

Signature of notice giver or notice giver’s solicitor or other duly authorised agent (please read guidance note 3).  If signing on behalf of the notice giver please state in what capacity. 

Signature		
Date	     	
Capacity	     	

For joint notices signature of 2nd notice giver or 2nd notice giver’s solicitor or other authorised agent (please read guidance note 4).  If signing on behalf of the applicant please state in what capacity.

Signature		
Date	     	
Capacity	     	

Contact name (where not previously given) and address for correspondence associated with this notice (please read guidance note 5)
     	
Post town	     	Post code	     	
Telephone number (if any)	     	
If you would prefer us to correspond with you by e-mail your e-mail address (optional)
     	

Notes for Guidance 

   1. The notice must be signed.

   2. Right to work/immigration status for individual applicants and applications from partnerships which
   are not limited liability partnerships:

A licence may not be held by an individual or an individual in a partnership which is not a limited liability partnership who: 
•	does not have the right to live and work in the UK; or 
•	is subject to a condition preventing him or her from doing work relating to the carrying on of a licensable activity. 

Any premises licence issued on or after 6 April 2017 will lapse if the holder ceases to be entitled to work in the UK.

Applicants must demonstrate that they have the right to work in the UK and are not subject to a condition preventing them from doing work relating to the carrying on of a licensing activity. They do this in one of two ways: 1) by providing with this application copies or scanned copies of the documents listed below (which do not need to be certified), or 2) by providing their ‘share code’ to enable the licensing authority to carry out a check using the Home Office online right to work checking service (see below). 

Documents which demonstrate entitlement to work in the UK

•	An expired or current passport showing the holder, or a person named in the passport as the child of the holder, is a British citizen or a citizen of the UK and Colonies having the right of abode in the UK [please see note below about which sections of the passport apply].

•	An expired or current passport or national identity card showing the holder, or a person named in the passport as the child of the holder, is a national of a European Economic Area country or Switzerland.

•	A Registration Certificate or document certifying permanent residence issued by the Home Office to a national of a European Economic Area country or Switzerland.

•	A Permanent Residence Card issued by the Home Office to the family member of a national of a European Economic Area country or Switzerland.

•	A current Biometric Immigration Document (Biometric Residence Permit) issued by the Home Office to the holder indicating that the person named is allowed to stay indefinitely in the UK, or has no time limit on their stay in the UK.

•	A current passport endorsed to show that the holder is exempt from immigration control, is allowed to stay indefinitely in the UK, has the right of abode in the UK, or has no time limit on their stay in the UK.

•	A current Immigration Status Document issued by the Home Office to the holder with an endorsement indicating that the named person is allowed to stay indefinitely in the UK or has no time limit on their stay in the UK, when produced in combination with an official document giving the person’s permanent National Insurance number and their name issued by a Government agency or a previous employer.

•	A birth or adoption certificate issued in the UK, together with an official document giving the person’s permanent National Insurance number and their name issued by a Government agency or a previous employer.

•	A birth or adoption certificate issued in the Channel Islands, the Isle of Man or Ireland when produced in combination with an official document giving the person’s permanent National Insurance number and their name issued by a Government agency or a previous employer.

•	A certificate of registration or naturalisation as a British citizen, when produced in combination with an official document giving the person’s permanent National Insurance number and their name issued by a Government agency or a previous employer.

•	A current passport endorsed to show that the holder is allowed to stay in the UK and is currently allowed to work and is not subject to a condition preventing the holder from doing work relating to the carrying on of a licensable activity.

•	A current Biometric Immigration Document (Biometric Residence Permit) issued by the Home Office to the holder which indicates that the named person can currently stay in the UK and is allowed to do the work in question.

•	A current Residence Card issued by the Home Office to a person who is not a national of an EEA state or Switzerland but who is a family member of such a national or who has derivative rights or residence.
 
•	A current Immigration Status Document containing a photograph issued by the Home Office to the holder with an endorsement indicating that the named person may stay in the UK, and is allowed to work and is not subject to a condition preventing the holder from doing work relating to the carrying on of a licensable activity when produced in combination with an official document giving the person’s permanent National Insurance number and their name issued by a Government agency or a previous employer.

•	A Certificate of Application, less than 6 months old, issued by the Home Office under regulation 18(3) or 20(2) of the Immigration (European Economic Area) Regulations 2016, to a person who is not a national of an EEA state or Switzerland but who is a family member of such a national or who has derivative rights of residence. 

•	Reasonable evidence that the person has an outstanding application to vary their permission to be in the UK with the Home Office such as the Home Office acknowledgement letter or proof of postage evidence, or evidence that the person has an appeal or administrative review pending on an immigration decision, such as an appeal or administrative review reference number.

•	Reasonable evidence that a person who is not a national of an EEA state or Switzerland but who is a family member of such a national or who has derivative rights of residence in exercising treaty rights in the UK including:- 

o	evidence of the applicant’s own identity – such as a passport, 
o	evidence of their relationship with the EEA family member – e.g. a marriage certificate, civil partnership certificate or birth certificate, and
o	evidence that the EEA national has a right of permanent residence in the UK  or is one of the following if they have been in the UK for more than 3 months:
(i)	working e.g. employment contract, wage slips, letter from the employer,
(ii)	self-employed e.g. contracts, invoices, or audited accounts with a bank,
(iii)	studying e.g. letter from the school, college or university and  evidence of sufficient
              funds; or
(iv)	self-sufficient e.g. bank statements.

Family members of EEA nationals who are studying or financially independent must also provide evidence that the EEA national and any family members hold comprehensive sickness insurance in the UK. This can include a private medical insurance policy, an EHIC card or an S1, S2 or S3 form.

Original documents must not be sent to licensing authorities. If the document copied is a passport, a copy of the following pages should be provided:

       (i)   any page containing the holder’s personal details including nationality;
       (ii)  any page containing the holder’s photograph;
       (iii) any page containing the holder’s signature;
       (iv) any page containing the date of expiry; and
       (v)  any page containing information indicating the holder has permission to enter or remain in
              the UK and is permitted to work.

If the document is not a passport, a copy of the whole document should be provided.

Your right to work will be checked as part of your licensing application and this could involve us checking your immigration status with the Home Office. We may otherwise share information with the Home Office. Your licence application will not be determined until you have complied with this guidance.	
Home Office online right to work checking service

As an alternative to providing a copy of the documents listed above, applicants may demonstrate their right to work by allowing the licensing authority to carry out a check with the Home Office online right to work checking service. 

To demonstrate their right to work via the Home Office online right to work checking service, applicants should include in this application their 9-digit share code (provided to them upon accessing the service at https://www.gov.uk/prove-right-to-work) which, along with the applicant’s date of birth (provided within this application), will allow the licensing authority to carry out the check. 

In order to establish the applicant’s right to work, the check will need to indicate that the applicant is allowed to work in the United Kingdom and is not subject to a condition preventing them from doing work relating to the carrying on of a licensable activity.

An online check will not be possible in all circumstances because not all applicants will have an immigration status that can be checked online. The Home Office online right to work checking service sets out what information and/or documentation applicants will need in order to access the service. Applicants who are unable to obtain a share code from the service should submit copy documents as set out above. 

3. A notice giver’s agent (for example solicitor) may sign the form on their behalf provided that they have actual authority to do so.

4. Where there is more than one notice giver, both notice givers or their respective agents must sign the application form.

5. This is the address which we shall use to correspond with you about this application.