LONDON PCO LICENCE APPLICATION FORM REGISTRATION

Please send your completed application form to: Markets Team Camden Council 211 Arlington Road London NW1 7HD photo of licensee here photo of licensee here Part one: Type of application Please specify what type of application you are making: New application Change of commodities Licence variation Type: Annual (markets) Casual registration (markets) Trading kiosk pitch Forecourt trading (leasing space) Temporary Events Licence number(s) (if renewal): Part two: Contact details Mr/ Mrs/ Miss/ Ms (please circle) Other title First names Surname Current postal address Contact telephone number(s) Date of birth National insurance number Town Postcode address 1Ģ (Continued) Part two: Contact details Nominated relative in the event of death of applicant Name Relationship to applicant Address Contact number(s) Part three: Application and trading location details Market/Site in which you wish to trade Number of pitch(s) required Preferred pitch number (if applicable) What type of goods do you want to sell? Give particulars of the articles or things you propose to offer for sale. You may wish to keep a copy of the completed form for your records. Camden Council is under obligation to protect the funds it administers and to this end may use the information that you have provided to this authority for cross system and cross authority comparison purposes for the prevention and detection of fraud. In all cases ensure that your answers are inside the boxes and written in black ink. If you are completing this form by hand please write in block capitals. 1 For official use only - Date received DD MM YEAR Application for a street trading licence London Local Authorities Act Please read the following instructions first Before completing this form please read the associated guidance notes which are on pages 5 and 6.

London pco licence application form