Request to be removed as designated premises supervisor from North Hertfordshire District Council

Step 2 of 3 Submit the application

Email address

Please provide your email address, so the licensing authority can let you know if your application has been successful or not.

Email address Confirm email address

Application form

Please attach the completed application form below.

Application form

Declaration

I confirm that a copy of this request to be removed as a designated premises supervisor has been given to the premises licence holder.
I/we understand it is an offence under section 158 of the Licensing Act 2003, to make a false statement in, or in connection with, this application liable on summary conviction to a fine up to level 5 on the standard scale.

Ticking this box indicates you have read and understood the above declaration

By continuing, you're giving the Cabinet Office permission to pass the information you're supplying to the relevant authority.

For more details on how your information is used please refer to the Government Digital Service privacy notice (opens in new tab) and North Hertfordshire District Council.