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Appendix 1

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Licensing Team, Argus Chambers, Hall Ings, Bradford, BD1 1HX

Application for a premises licence to be granted 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 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.

Wer..... lseare... NAGS PEETRE ( CHA Cha Ghaid L caamauaee (insert name(s) of applicant)

apply for a premises licence under section 17 of the Licensing Act 2003 for the premises described in Part 1 below (the premises) and I/we are making this application to you as the relevant licensing authority in accordance with section 12 of the Licensing Act 2003

Part 1 Premises Details

Onr 6 ; Chea chA Chf!

IN GLABYO ROPA

_ Non domestic rateable value of premises £ 3,460

Part 2 Applicant Details

Please state whether you are applying for a premises licence as:

Please tick as appropriate a) an individual or individuals* L] please complete section (A)

b) a person other than an individual"

i. asa 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) a recognised club please complete section (B)

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d) acharity please complete section (B)

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f) a health service body [] please complete section (B)

e) the proprietor of an educational establishment please complete section (B)

g) a person who is registered under Part 2 of the Care C] please complete section (B) Standards Act 2000 (c14) in respect of an independent hospital in Wales

ga) a person who is registered under Chapter 2 of Part 1 [] please complete section (B) of the Health and Social Care Act 2008 (within the meaning of that part) in an independent hospital in England

h) the chief officer of police of a police force in England [C] please complete section (B) and Wales

“If you are applying as a person described in (a) or (b) please confirm (by icking yes to one box below:

e lam carrying on or proposing to carry on a business which involves the use of the C] premises for licensable activities; or

e | am making the application pursuant to a

o statutory function or o a function discharged by virtue of Her Majesty’s prerogative

LI LI

(A) INDIVIDUAL APPLICANTS (fill in as applicable)

Other title

Mo L] ms C] miss C] ms [_] (for example, Rev)

Surname First names

penn ||

Please tick yes

Date of Birth fF l | am 18 years old or over [|

Current postal address if different from premises address

16

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)

SECOND INDIVIDUAL APPLICANT (if applicable)

Other title

Mr C] Mrs C] Miss C] Ms C] (for example, Rev)

Surname First names

_ |

Please tick yes

Date of Birth fF | am 18 years old or over C] Nationality |

Current postal address if different from premises address

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) OTHER APPLICANTS

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

Address CHA ChA ChM

unit Ko. INe Road ARMO ESD ADK GAN

CHA CHA chAi INGRI LTO Comand Rezisag Als 11642216

Registered number (where applicable)

17

Description of applicant (for example, partnership, company, unincorporated association etc.)

Limited Cam Pani

E-mail address (optional)

Part 3 Operating Schedule AS Son Ak Asi Rte

Da Month Year

When do you want the premises licence to start?

Da Month Year If you wish the licence to be valid only for a limited period, when do you want it to end?

Please give a general description of the premises (please read guidance note 1) Siete ADe G0 fr DEPA RLANG LOCA aulitiual A fost fader oF FUE anm foo dal. LE CARR ak OVER Aco VEHICLES . CALE 1S THE MAIN USE SUNE Hat links AND Lint SNAS . Ana REERAWMEN TS. l

If 5,000 or more people are expected to attend the premises N Ja at any one time, please state the number expected to attend

What licensable activities do you intend to carry on from the premises? (Please see sections 1 and 14 of the Licensing Act 2003 and Schedules 1 and 2 to the Licensing Act 2003) Please tick M yes

Provision of regulated entertainment a) plays (if ticking yes, fill in box A)

b) films (if ticking yes, fill in box B)

c) indoor sporting events (if ticking yes, fill in box C)

d) boxing or wrestling entertainment (if ticking yes, fill in box D) e) live music (if ticking yes, fill in box E)

f) recorded music (if ticking yes, fill in box F)

g) performance of dance (if ticking yes, fill in box G)

h) anything of a similar description to that falling within (e), (f) or (g) (if ticking yes, fill in box H)

Provision of late night refreshment (if ticking yes, fill in box l)

Sale by retail of alcohol (if ticking yes, fill in box J)

Ey SE ELITES

In all cases complete boxes K, L and M

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Plays Will the performance of a play take place indoors or Standard days and timings outdoors or both please tick (please read guidance note

(please read guidance note 7) ‘| 3)

Please give further details here (please read guidance note 4)

State any seasonal variations for performing play (please read guidance note 5)

Non standard timings. Where you intend to use the premises for the performance of plays at different times to those listed in the column on the left, please list (please read guidance note 6)

Films Will the exhibition of a films take place indoors or Standard days and timings outdoors or both please tick (please read guidance note

(please read guidance note 7) 3)

fons |

Please give further details here (please read guidance note 4)

Tue

State any seasonal variations for the exhibition of films (please read guidance note 5)

Non standard timings. Where you intend to use the premises for the exhibition of films at different times to those listed in the column on the left, please list (please read guidance note 6)

pasa BWEN pa ee sel pa Es! Thur 7, TE | = = [a py ee

indoor sporting events Please give further details (please read guidance note 4) Standard days and timings

(please read guidance note 7)

State any seasonal variations for indoor sporting events (please read guidance note 5)

Non standard timings. Where you intend to use the premises for indoor sporting events at different times to those listed in the column on the left, please list. (please read guidance note

Boxing or wrestling Will the boxing or wrestling entertainment take place

entertainment indoors or outdoors or both please tick (please read [maos | O | Standard days and timings guidance note 3) i Outdoors (please read guidance note 7)

Please give further details here (please read guidance note 4)

State any seasonal variations for the boxing or wrestling entertainment (please read guidance note 5)

Non standard timings. Where you intend to use the premises for boxing or wrestling entertainment at different times to those listed in the column on the left, please list. (please read guidance note 6) :

20

Live music Standard days and timings (please read guidance note 7)

Day

Recorded music Standard days and timings (please read guidance note 7)

Will the performance of live music take place indoors indoors = | O or outdoors or both please tick (please read guidance

Please give further details here (please read guidance note 4) State any seasonal variations for the performance of live music (please read guidance note 5)

Non standard timings. Where you intend to use the premises for the performance of live music at different times to those listed in the column on the left, please list. (Please read guidance note 6)

Will the playing of recorded music take place indoors or outdoors or both please tick (please read guidance

Please give further details here (please read guidance note 4) State any seasonal variations for the playing of recorded music (please read guidance note 5)

Non standard timings. Where you intend to use the premises for the playing of recorded music at different times to those listed in the column on the left, please list. (please read guidance note 6)

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Performance of dance Standard days and timings (please read guidance note 7)

+ la D

Anything of a similar description to that falling within (e), (f) or

Standard days and timings (please read guidance note 7)

Will the performance of dance take place indoors or | Indoors | outdoors or both please tick (please read guidance note :

Please give further details here (please read guidance note 4) State any seasonal variations for the performance of dance (please read guidance note 5)

Non standard timings. Where you intend to use the premises for the performance of dance at different times to those listed in the column on the left, please list. (please read guidance note 6)

Please give a description of the type of entertainment you will be providing

Will the entertainment take place indoors or outdoors or both please tick (please read guidance note 3)

Please give further details here (please read guidance note 4)

State any seasonal variations for the entertainment of a similar description to that falling within (e), (f) or (g) (please read guidance note 5)

Non standard timings. Where you intend to use the premises for the entertainment of a similar description to that falling within e), f) or g) at different times to those listed in the column on the left, please list. (please read guidance note 6)

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Late night refreshment Will the provision of late night refreshment take place oa days and timings indoors or outdoors or both please tick (please read

= ie PEN Please give further details here (please read guidance note 4)

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14.60 State any seasonal variations for the provision of late night refreshment (please read 4400 | “PE? me onne <A Wie BE BL ALL MoumMs mw [14.00

EFA 60 23 -DO | Non standard timings. Where you intend to use the premises for the provision of late night

refreshment at different times to those listed in the column on the left, please list. (please 22-00 | 00 | 11.06 | read guidance note 6)

Pico tae fae TIMINS ARE FOL ZW AS AL Columns 23.66.

11.00. 00| 24-00

Supply of alcohol Will the supply of alcohol be for consumption on or off | On the premises fe se Standard days and timings the premises or both please tick (please read guidance (please read guidance note 7) note 8) Off the premises DO |

State any seasonal variations for the supply of alcoho! (please read guidance note 5)

Non standard timings. Where you intend to use the premises for the supply of atcohol at

different times to those listed in the column on the left, please list. (please read guidance note 6)

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State the name and details of the individual whom you wish to specify on the licence as the designated premises supervisor (please see declaration about the entitlement to work in the checklist at the end of the form)

Name

N la Na ALChòtol

Address

Postcode Personal licence number (if known)

Issuing licensing authority (if known)

Please highlight any adult entertainment or services, activities, other entertainment or matters ancillary to the use of the premises that may give rise to concern in respect of children (please read guidance note 9)

MTA

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Hours premises are State any seasonal variations (please read guidance note 5) open to the public

Standard days and timings is S6Adonlae Unt tATIOAAS (please read guidance note 7)

[Day [sun [rmen

Tue 11.56 Non standard timings. Where you intend to open the premises to be open to the public at Thur S times from those listed in the column on the left, please list. (please read guidance DIN Me Mantani as Mal coomas

Describe the steps you intend to take to promote the four licensing objectives:

a) General all four licensing objectives (b, c, d, e) (please read guidance note 10) WE WAJE PUL CAMA 24h ReLoaMné mo MAIDNE cary fivenité HYochen Wite BE on Sie I2hs Pat OM Ano Attoes LIS MEN L mie Kwit Mou Siré.

Non AL CUdakal LICONSÉ.

b) The prevention of crime and disorder

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AYO we AE A TALÈ ikh AND Go SICE. we Meroe FANS AND lure IS AMALÉ ONING AND Cot AIO None IN lm WG

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we hive Kase mab ak AAL AWA S AMDAN Ar Ade Tuck.

d) The prevention of public nuisance Aase ANa music Add APUCAMLE to ode vse. nic hhc A OU TIME OME WULE cles lLanaz

No Coats OR OUIrd6 ON STE wa AZ Poccotionas

The protection of children from harm

Nan APArcedtic DWE tru CAG AND hion” SNAS

Save GUEA ISA BALAA ATINDANT, To RE Peer Burt MUDA SATUCOAT SUAAI in NN VIS AZBZAMAG PMKING Conte

Ar ve MAJ ENTRANCE 26

Checklist Please tick to indicate agreement

e | have made or enclosed payment of the fee ea e | have enclosed the plan of the premises

e | have sent copies of this application and the plan to responsible authorities and others where applicable

e | have enclosed the consent form completed by the individual | wish to be designated premises supervisor, if applicable

e | understand that | must now advertise my application

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

WV RRA

Applicable to all individual applicants, including those in partnership which is not a limited liability partnership, but not companies or limited liability partnerships

e | have included documents demonstrating my entitlement to work in the United Kingdom or my share code issued by the Home Office online right to work checking service (please read note 15)

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 PURUANT 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 note 11)

Signature of applicant or applicant’s solicitor or other duly authorised agent. (See guidance note 12). If signing on behalf of the applicant please state in what capacity.

Applicable to individual applicants only, including those in a partnership which is not a limited liability partnership

e | understand | am not entitled to be issued with a licence if | do not have the entitlement to live and work in the UK (or if | am subject to a condition preventing me from doing work relating to the carrying on of a licensable activity) and that my licence will become invalid if | cease to be entitled to live and work in the UK (please read guidance note 15).

e The DPS named in this application form is entitled to work in the UK (and is not subject to conditions preventing him or her from doing work relating to a licensable activity) and | have seen a copy of his or her proof of entitlement to work, or have conducted an online right to work checking service which confirmed their right to work (please see note 15).

cain eee Date ax- OBA- Is62h Capacity

Declaration

For joint applications signature of 2" applicant or 2" applicant's solicitor or other authorised agent. (please read guidance note 13). If signing on behalf of the applicant please state in what capacity.

some [ w e

Contact Name (where not previously given) and address for correspondence associated with this application (please read guidance note 14)

ISZLAR NARI [ES Asa kaa

Post town Rezo men Post code ROE a ap Telephone number (if any) me nn

Ifyou would prefer us to correspond with you by e-mail, your e-mail address (optional)

L enn

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