Application Forms

Application for a Club Premises Certificate

Application for a Personal Licence

Application to disapply the condition requiring a DPS in respect of Community Premises

Change of Name or Address

Interim Authority Notice

Licensing Fees

Minor Variations

Names and Address of Responsible Authorities

New Premises

Notification of Interest

Performances of Hypnotism

Provisional Statements

Removal of a Designated Premises Supervisor

Review of a Premises Licence

Surrender of a Premises Licence/Club Premises Certificate

Temporary Event Notice

Transfer of a Premises Licence Holder

Variation of a Designated Premises Supervisor

Please read the following information carefully:

The application to vary a premises licence to specify an individual as designated premises supervisor under the Licensing Act 2003 asks the licensee to give a copy of the form to the existing premises supervisor. The completed form contains personal information about the proposed new DPS and sharing this information would be in breach of the Data Protection Act 1998. It is sufficient for the licensee to inform the DPS that the application has been made, without the need to share the specific details of the application. A full copy of the application form must still be sent to police. The form will be amended via regulations as soon as possible to make this clear.

Variation of a Premises Licence / Club Premises Certificate


Code of Data Matching Practice
This Council is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes. For further information, contact the Council's Data Protection Officer on 01773 841670.

Contact Details
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Do you need further information?

If for some reason you are unable to find the information which you require on our website, you can contact us by the following methods.


address logoAmber Valley Borough Council, Licensing Section, Town Hall, Market Place, Ripley, Derbyshire, DE5 3BT
address logo01773 570222 *Calls are recorded for quality and training purposes
address logolicensing@ambervalley.gov.uk
address logoComplete our online enquiry form
address logoText the word COUNCIL followed by your message to 60060 *Standard network rates apply
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