LICENSE APPLICATION

Shops & Stores License

Please fill out all relevant fields in the application form below.

Select License Type

Full Name

Phone Number

Postal/Mailing Address Organization Name (if applicable)

Purpose / Justification

Facility Information

Name of premises * Full postal address * Date when musical performances began or will begin * Area where music will be audible * Describe the area Floor area over which music will be audible (sq. ft.) *

Business Details

VAT Registration No * Company name * Please use CAPITAL LETTERS

Additional Information

Portable radio or radio-cassette without extension (quantity) Enter number of instruments Radio with extension speaker(s) (quantity) Enter number of instruments No. of TV screens (screen(s) no greater than 26") Enter number of screens No. of TV screens (screen(s) greater than 26") Enter number of screens Record/CD/DVD player (quantity) Enter number of instruments Tape player (quantity) Enter number of instruments Video player (quantity) Enter number of instruments Other equipment (please specify) Other equipment (quantity)

Ownership Details

Function of applicant * e.g., Proprietor, Director, Financial Controller Applicant name * Please use CAPITAL LETTERS Applicant full postal address * Please use CAPITAL LETTERS Email Address * Telephone No. * Fax No.

I apply for this license.

I understand that this application will be reviewed and that the information provided is accurate.

I hereby agree and certify that the information provided is accurate

Thank you! Your submission has been received!

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Shops & Stores License

Facility Information

Business Details

Additional Information

Ownership Details

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