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Designated Premises Supervisor (DPS) consent form

1. Complete this form to give consent to be named as a new DPS on a premises licence.
  
  For more information see DPS variation - premises licence.
  
  This form is one page long and will take a few minutes to complete.
2. DPS details
  1. Full name
  2. Address line 1
  3. Address line 2 (optional)
  4. Town/city
  5. Postcode
  6. Telephone number
  7. Email address
  8. Personal licence number
  9. Personal licence issuing authority
3. Premises details
  1. Premises name
  2. Address line 1
  3. Address line 2 (optional)
  4. Town/city
  5. Postcode
  6. Telephone number
  7. Email address
  8. Premises licence number (optional)
4. Declarations
  1. Name of person completing this form
  2. I hereby confirm that I give my consent to be specified as the DPS concerning the supply of alcohol on the premises of which the application relates.
  3. I confirm that I am entitled to work in the UK and am applying for, intend to apply for, or currently hold, a personal licence.
7. Preston City Council will use your information in a manner compatible with the General Data Protection Regulation (GDPR).
  
  Any disclosures or sharing of information will only take place where required or permitted by law. For further information please see our privacy notice .