I declare that the particulars given by me on this form are true and I hereby make application to ¾ÅÐãÖ±²¥ for the grant of the licence applied for above. I understand that I, or any person who, in connection with the making of this application makes any statement which I/they know to be false or recklessly makes any statement which is false in a material particular shall be guilty of an offence and liable, on summary conviction, to a fine not exceeding £2500.00.
I also confirm that, if granted a licence, I will comply fully with the conditions of that licence and have, previous to lodging this application, made myself familiar with the terms of ¾ÅÐãÖ±²¥s’ standard conditions pertaining to the licence.
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