Application for a premises licence to be granted unaler the Licensing Act 2003

PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST

Before completing this lbrm please read the guidance notes at the end ofthe folm. Ifyou are completingthis folm by hand please write legibly in block capitals. In all cases ensure that your answers are inside theboxes and written in black ink. Use addifional sheets ifnecessary.

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

Itwe !18_f[41i_!!PETEI]f4U,,,....._....__-__ 7s, hse;; ;a;e'r or apii,:;n;/

apply for a pr€mises licence under section 17 ofthe Licensing Act 20031or the premises described inPart 1 belo* (the premises) and Uwe are making this application lo you as the relevant licensingauthodtv itr accordance with section 12 ofthe Licensing Act 2003

Part I - Premises D€tails

Telephone number at premises (if any) 020 8s72 s7s8

Non-domestic rateable vaiue of premises t?,600.00

Pal1 2 - Applicant Details

Please stale whether you are applying for a premises licence as

a) an individual or individuals *

b) a person other than an individual *

i. as a lil1lited company

ii. as a partnership

iii. as an unincorporated association or

iv. other (for example a statutory corporation)

Please t;ck as appropriate

X please complete section (A.)

n!nnn!!

please conplete section (B)

please complete section (B)

please complete section (B)

please complete seciion (B)

please complete section (B)

please complete section (B)

please complete section (B)

c)

4

a recognised club

a cnanry

the proprietor of an educational establishnrent

Postal address olpremises or. ifnone, ordnance survey map reference or description

POLKA STORX168 HESTON ROADHESTON

Post town HOUNSLOW Postcode TWs oQU

0 a health service body tr please complete section (B)

g) a person who is registered under Part 2 ofthe Care n please complete section (B)Standards Act 2000 (c14) in respect ofar independenthospital ;n Wales

ga) a person who is registered under Chapter 2 ofPart 1 ! please complet€ section (B)ofthe Health and Social Care Act 2008 (within themeaning ofthat Part) in an independent hospital inEngland

h) the chiefolficer ofpolice ofa police force in England n please complete section (B)and Wales

* Ifyou are applying as a person described in (a) or (b) please confim:

Pl€ase tick yes

I am carrying on or proposing to carry on a business which involves the use ofthe premises for Xlicensable activities; orI am making the application pusuant to a

stahrtory fimction or !a function discftarged by virtue ofHer Majesty's prerogative n

(A) INDI!'IDUAL APPLICANTS (fill in as applicable)

MrXMrs!Mi>s!v 'n Other Tide (iorexample, Rev)

SurnameMANMEET

Firsl nam€sSINGH

I aln 1 8 years old or over X Please tick yes

Current postal address ifdifferent from prcmisesaddrcss

Post lown I Postcode

Da)'time contact tel€phone lumber 7

E-mail addrcss(optional)

SECOND INDMDUAI- APPLICANT (if applicable)

.B) OTHER APPLICANTS

Plerse provide name and register€d address of applicaDt in full. Where appropriate please give anyr€gistered number. In the case of a parttrership or other ioint venture (other than a bodycorporat€), please give the name and address of €ach party conc€rned.

\4r ! Mrs n viss ! v' nOther Title (forexample, Rev)

Surnam€ First names

I am 1 8 years old or over n Please tick yes

Curent postal address ifdifferent from premisesaddress

Postcode

Daltime contrct teleDbone number

E-mail address(optional)

Name

Address

Registered number (where applicable)

Desoiption ol applicant (for example, partne.ship, compaiy, unincorporated association etc.)

Telephone number (if any)

E-mail addrcss (optional)

Part 3 Operating Schedule

Wlen do you want the premises licence to start?

Ifyou wish the licence to be valid only for a limited pedod, when do youwa.nt it to end?

DD MM

MMDD

Please give a general description of the premises (please read guidance note I )

A MODERN LOCAL COMMUNITY CONVENIENCE STORE WITH POLISH FOODSPNCIALITY.

If 5,000 or more people are expected to attend the ptemises at any one time,Dlease state the number exDected to attend.

What licensable activities do you intend to carry on from the premises?

(Please see sections I aid 14 ofthe Licensing Act 2003 ard Schedules 1 and 2 to the Licensing Act 2003)

Provision of regulated entertainment Please tick any thatapplv

b)

c)

o)

D

n)

plays (ifticking yes, fill inbox A)

films (if ticking yes, filI in box B)

indoor sporting events (iftickingyes, fill in box C)

boxing or wrestling entertainment (ifticking yes, fill in box D)

live music (ifticking yes, fill in box E)

recorded music (iftickingyes, fillin box F)

performarces ofdance (iftickingyes, fillin box G)

an)thing of a similar description to that falling within (e), (0 or (g)(ifticking yes, fill in boxH)

Provision ol lat€ triqht refr€shment (ifticking yes, fill in box I)

Sgpplyglqhqlq! (ifticking yes, fiil in box J)

In all cas€s complete boxes Ig L and M

n!

!

nntr!

n!

x

J

Supply ofalcoholStandard days and timings(please read guidance note6)

Will the supplv ofalcohol be lor consumption -p!eg!g1!!g! (please read guidance note ?)

On thepremises nOiflhepremNes

Dry Stad Finish Both !Mon 08:00 23:00 Sttte anv seasonal va ations lor the suDDly of alcohol (please read

guidance note 4)

NONEHRS HRS

Tue 08:00 23:00

IIRS HRS

08:00 23:00

HRS IIRS

Thur 08r00 23:00 Non slaldard t imiDqs. \ \ bere vou intetrd lo use tbe premises for thesuppl! ofalcohol at di f fer€nt r imes ro lhose l isred in the columtr oo the

HRS HRS !gitdg$q!!g (please read guidance note 5)

NONEFri 08:00 23:00

HRS HRS

Sat 08:00 23:00

HRS HRS

Sun 08:00 23:00

IIRS HRS

State the name and details ol the individual whom you wish to specify on the licence as designatedpremises supervisori

NameMR IIANMEET SINGH

Address

Postcode

Personal licence number (ilknown)

lssuing licensing authority (if known)

Please highlight any rdult enlertainmetrt or s€rvices, activities, other edtertainment or mattenancillary lo the use of the premises that may give rise to concern in respect of children (please readguidance note 8).

NONE

K

L

Ilours premises are opento th€ publicSfandard days and limings(please read guidance note

State anv seasonal variations (please read guidance note 4)

NONE

Day Sta Finish

Mon 08:00 23:00

IIRS IIRS

Tue 08:00 23:00

IIRS HRS

Wed 08:00 23:00

HRS HRS Non standard timinss. Where vou intend the premises to be op€n to theputllic at different times from those listed in the column on th€ leftp!g3!g!!q! @lease read guidance note 5)

NONf,

Thur 08:00 23:00

HRS HRS

Fri 08:00 23:00

HRS HRS

Sat 08:00 23:00

HRS HRS

Sun 08:00 23r00

HRS HRS

M Describe the steps you intend to take to prcmote the four licensing objectives:

a) General all four ectives ab. c. d and e read suidance note 9

STRICT IMPLf,MENTATION OF'CHALLENGE 25 POLICYALL STAFF TO BE TRAINED IN Rf,SPONS]BLE ALCOHOL RETAILING

b) The Drevention ofcrime and disorder-TIIE PR.EMISES SILA.LL INSTALL AND MAINTAIN A COMPRf,HENSIVE CCTV SYSTEMWIIICH RECORDS 24 HOURS A DAY. ALL ENTRY AND EXIT POINTS WILL BE COVEREDENABLING FRONTAL IDENTTFICATION OF EVERY PDRSON ENTERING TN ANY LIGHTCONDITION.- ALL CCTV RECORDINGS SHALL BE STORID FOR A MINIMUM PERIOD OF3l DAYSAND ALL RECORDINGS WILL BE STAMPED WITII TIIE DATE AND TIME. VIEWING OFRECORDINGS SHALL BE MADf, AVAILABLE, SUBJECT TO DATA PROTf,CTIONLEGISLATION! IMMEDIATELY UPON THf, RXQUEST OF POLICE OR AN AUTHORISEI)COUNCIL OF'F'ICER.- A STAFF MEMBER FROM THE PREMISES WHO IS CONVERSANT WITH THEOPERATION OF THE CCTV SYSTEM SHALL BE ON THE PREMISES AT ALL TIMESWHEN TIIE PROMISES ARE OPEN. THIS STAFF MEMBER MUST Bf, ABLE TO PROVIDE APOLICE OR AUTIIORISED COUNCIL OFFICER COPIES OF RECENT CCTVIMAGES ORDATA WITH THE MINIMI]M OF DELAY WHEN REQUESTED.- SIGNAGE WILL BE PROMINENTLY DISPLAYED ADVISING CUSTOMERS TIIAT THEYARE BtrING FILMED ON CCTV.-ALL PURCHASES FROM CASII AND CARRY ONLY-INCIDENT BOOK IN PLACE AND UPDATI] REGULARI-Y-NO BUSINESS RELATIONSHIP WITII PRIVIOUS LICENCE HOLDER

-INSTALLATION OF APPROPRIATE SAFETY EQUIPMENT.-INSTALLATION OF OMERGENCY LIGIITING-TO COMPLY WITII ALL CURRENT, FIRf, AND IIEALTE AND SAFETY LNGISLATION-STAFF TO BE TRI.INED ON FIRE SAFETY AND EMERGENCY EVACUATIONS

- NOTICES WILL BE PROMINf,NTLY DISPLAYED AT THf, trXIT REQUI]STING THATRESIDf,NTS RESPECT TIIE NATURf, OF THE Rf,SIDf,NTIAL AREA AND LEAVE OUIf,TLY- TO MONITOR ANTI SOCL{L BEIIAVIOUR BY USE OF CCTV

on ofDubl ic nuisance

e) The proteclion of children from harm-A CHALLENGE 25 PROOF OF AGN SCHtrME SHALL OPERATE AT THE PREMISES.SIGNAGE SILA.LL BE DISPLAYED ADVISING CUSTOMERS THAT THE SCHEME IS INPLACf,.-A REFUSALS BOOK SHALL BE KEPT DETAILING ALL RI]FUSED SALES OF ALCOHOL,THE RECORD SHOULD INCLUDf, TIIE DATE AND TIME OF THE REFUSED SAL[, ADESCRIPTION OF THE REFUSAL AND TIIE NAMf, OF TIIE MEMBER OF STAFF WHORXFT]SED THE SALE. RECORDS SIIALL BE KEPT ON THE PREMISES AND MAINTAINEDF'OR A MINIMUM OF 12 MONTIIS. RECORDS WILL BE MADE AVAILABLE FORINSPECTION AT THE PREMISES BY THE POLICE ORANAUTHORISED OFF'ICER OF THECOUNCIL AT AI-L TIMES-ALCOHOL TO BE KEPI AWAY FROM CHILDRTNS CONFECTIONf,RY SIIELVES-CHALLENGE 25 POSTERS DISPLAYED ACROSS TIIE PREMISES-SPIRITS & CIGARETTES TO BE KEPT BEHIND THE COUNTER-REFUSAL BOOK IN PLACE AND FILLED OUT ON A REGULAR BASIS.

ChecldistlPlease tick to indicate agre€ment

. I have made or enclosed payment ofthe fee. X

. I have enclosed the plan ofthe premises. X

. I have sent copies ofthis application and ihe plan to responsible authorities and others where tvtapplicable.

. I have enclosed the consent form completed by the individual I wish to be designated premise! vtsupefl isor, if applicable.

. I understand ihat I must now advertise my application. X

. I undeftand ihat ifl do not comply with the above requirenents my application will be Xrejected.

IT IS AN OFFEI{CE, LLABLE ON SUMMARY CONVICTION TO A FINE NOT EXCEEDINGLEVEL 5 ON THE STANDARD SCALE, UNDER SECTION 158 OF TIIE LICENSING ACT 2003,TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH TIIIS APPLICATION.

Part 4 - Signatures (please read guidance note 10)

Signature of applicant or applicant's solicitor or other duly ruthorised agent (see guidance note I l).ff signing otr b€hau of the applicant, pleas€ state in rvhat capa€ity.

For joint applications, signature o12'd applicant or 2"d applicantis solicitor or otber authorisedagent (please read guidance note I 2). If signing on behalf of the applicant, please slate in what

Signature

Dale

Capacity

Contact name (where noi previously given) and postal address lor conespondence associated with thisapplication (please read guidance nole 13)MANPREET SINGH KAPOORPERSONAL LICENCE COURSES LTDSTUDIO 8IIAYES BUSINESS STI]DIOHAYES CAMPUSCOLLEGD WAY

Posttown HAYIS Postcode UB3IBBTetephone nu,.nber (if any) 020 8606 0ss8If you would prefer us to correspond with you by e-mail, your e-mail address (optional)info@tersonallicensecours€s.co. k

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ffiCCTV RECOROING 31 DAYS