Name

Full name of person/s who will be responsible for the licence/tenancy

First Name

Last Name

Home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date

When would you like to take up occupancy? (Preferred date)

MM

DD

YYYY

Is your business new or established?

Please select

New

Established

Have your items been P.A.T. tested?

All portable, electrical items brought onto LCVS Enterprises premises must be P.A.T. tested

Yes

No

P.A.T. testing

If you answered 'yes' above, please provide a copy of the P.A.T. report. If 'no', we will arrange for the items to be P.A.T. tested at your expense

I will email a copy of my report

I will need LCVS Enterprises to arrange P.A.T. testing for me

Machinery/equipment

Does any of your machinery, equipment or any materials you use create any of the following? (Tick all that apply)

Noise

Smell

Smoke

Fumes

Vibration

Hazards

Your insurer's address

Address of company you are insured with

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Insurance

What level of insurance cover do you hold? (Tick all that are relevant)

Loss of property/equipment

Public liability

Employer's liability

Your bank address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Referee address

Please give the address of your referee

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country