Application form by p8afbaQP

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									  Form A

                                                     LONDON LOCAL AUTHORITIES ACT 1991
                                                 ESTABLISHMENT FOR SPECIAL TREATMENT
                                                          APPLICATION FOR NEW LICENCE


 This form should be completed and forwarded to the relevant authorities. See attached for
                                  methods of payment
  I/We apply for a licence to carry on an establishment for or special treatment under Part II Section 10(1)
  of the London Local Authorities Act 1991, in the London Borough of Lewisham.

Trade Name or Title under which establishment is to be carried on: …………………………………………………..
Address:…………………………………………………………………………………………………………………………..
Tel No:………………………………………………………………………………………………………………………….


Which part of the building is proposed to be used for special treatment
……………………………………………………………………………………..……………………………………….


NOTE:         See Part 3 of Guidance Notes regarding the requirement to submit plans of the premises.
Name(s) of applicant(s) (individual\partnership\unincorporated organisation):
Full name:         ......................................................................................................................................................
Home Address: ……………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………….
Tel No:            ......................................................           Over 21                   Yes                      No
Full Name:         ...................................................................................................................................................... .

Home                                                                                                                                                           Address:
                   ………………………………………………………………………………………………………………
Tel No:            ......................................................           Over 21                   Yes                      No
(continue on separate sheet if necessary)
Have you/the unincorporated company/corporate company ever been refused a licence by this or any other
authority or been convicted within the last five years of any offence under Part II of the London Local Authorities Act
1991?
Yes              No               If yes, please give particulars: ..........................................................................




This part to be completed if application is made by a limited liability company or other incorporated body

Name of Company or Incorporated Body: ..........................................................................................................
Address of Registered Office: .......................................................... ………………………………………………..
……………………………………………………………………..….. Tel No: ……………………….………………..
Particulars of Directors:-
Full Name:         ……………………………………………………………………………………………………………….
Address:       ............................................................................................................................................................
              ……………………………………………………………. Tel No: ........................................................
Full Name: …………………………………………………………………………………………………………………...
Address:       …………………………………………………………………………………………………………………...
              ………………………………………………………….… Tel No: …………….…………………………....



  STL
                                                                                                                                                Form A continued
Name and Address of Person responsible for the establishment if different from the applicant:

Name:                   ........................................................................................................................................

Home Address: ........................................................................................................................................

                        …...………………………………………………………………………………………………

                        ………………………………………..                                                  Tel No: ......................................................

List all treatments intended within the establishment:

………………………………………………………                                                                     …………………………………………………..

………………………………………………………                                                                     …………………………………………………..


………………………………………………………                                       …………………………………………………..
(continue on separate sheet if required - see scale of fees)

NOTE - Form B must be completed if                              massage is listed above, by the individuals that will carry out the
treatment within the establishment.

State relevant qualification of person(s) making application:-

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….
(continue on separate sheet if required)
Is it proposed to employ staff at the establishment? Yes

If yes, how many? Male: ..................................                     Female: ..................................

NOTE - A passport size photograph and a copy of all relevant qualification certificates is required of all
persons operating on the establishment.
Is it intended to give treatment in conjunction with a hairdressing business? Yes         No

State the proposed methods of advertising your business, attaching samples, if available:

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….

The fees specified are payable in respect of applications for the grant renewal or transfer of licences. An
application fee, or part of a fee, may be retained by the Council whether or not a licence is granted.


  Checklist (Please mark the appropriate with an X)
  I Shall
  Send one copy to the licensing Authority
  I have forwarded copies of the application form and plan to the relevant authorities ( Planning, LFEPA,
  and the Police)
  I have made or enclosed payment of fee
  I have enclosed a plan of the premises – no larger than A3
  I have provided x 2 passport photographs
  I have provided Copies of all relevant qualifications of all persons operating on the establishment
  Sign the declaration below

  I declare that the above details are correct to the best of my knowledge.

Signed: ...........................................................................         Date: ..........................................................

  The Licensing Authority must be immediately informed of any changes to staff operating within the establishment
  or any changes in addition under which the licence was granted.


  STL
Form B

APPLICATION TO CARRY OUT THE TREATMENT OF MASSAGE

FOR THE PURPOSES OF THIS APPLICATION
Massage refers to the gentle manipulation of body tissue by direct touch with or without essential oils and includes
such techniques as massage, aromatherapy, reflexology, Rosen Method and similar techniques.

This does not include massage of the face, neck, scalp and feet, or electrical massage/toning techniques used in
conjunction with body treatments.

Full Name: ............................................................................         Over 21 Yes                         No

Home Address: ........................................................................................................................................

……………………………………………………………………………………………………………………….

State specific massage treatment to be carried out:

……………………………………………………………………………………………………………………….

Address(es) where treatments to be carried out:

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….

List qualifications concerned with treatments, giving specific details of training:
(enclose a copy of relevant certificates)

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….

Details of last employment (if you wish, please give other work experience to support your application):

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….

Have you ever been refused a licence by this or any other Local Authority? Yes                                                      No

……………………………………………………………………………………………………………………….


……………………………………………………………………………………………………………………….

State the proposed methods of advertising your business, attaching samples, if available:

……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………….

I declare that the above details are correct to the best of my knowledge

Signed: .............................................................................              Date: .............................................

The applicant for the licence must provide a passport size photograph of him/herself and attach it to the form.




  STL

								
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