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Premises licence application - representation form

This representation form can be used to submit representations about a current application to the licensing service.

Please see guidance notes on How to comment or complain about licensed premises | Islington Council for further information and advice about making a representation.

First name

Last name

Home address

In what capacity are you making this submission?

If other, please specify:

Telephone number

Email address

Premises name

Address of premises

Licence application reference number (if known)