LICENSE APPLICATION

Banks, Offices & Industrial Premises Licence

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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 *

Business Details

VAT Registration No * Company name * Please use CAPITAL LETTERS

Additional Information

No. of employees to whom music will be audible at their work stations * Estimated no. of weeks on which performances will take place during the year * Area/square footage where music will be audible to members of the public (sq. ft.) * Do you use a music-on-hold facility on your switchboard? *

Yes No

Music-on-hold supplier name If yes to music-on-hold Number of external lines on switchboard

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. *

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

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Banks, Offices & Industrial Premises Licence

Facility Information

Business Details

Additional Information

Ownership Details

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