Sale of Alcohol Authorisation form
Name of Venue
*
Date
*
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Day
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Month
Year
Date
Name of Designated Premises Supervisor
First Name
Last Name
DPS/Venue Email Address
example@example.com
The above named Designated Premises Supervisor authorise the following persons to sell alcohol under the Licensing Act 2003 on these premises at any time during the permitted hours and in accordance with the premises licence. This authority applies whether or not I, or any other Personal Licence holder, are present on the premises at the time of the sale or supply of alcohol. I can confirm these persons have been made aware of his/her legal responsibilities under the Act.
Name
First Name
Last Name
Signature
Name
First Name
Last Name
Signature
Name
First Name
Last Name
Signature
Name
First Name
Last Name
Signature
Name
First Name
Last Name
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