ࡱ> HKEFGg 9bjbjhh OD|\|\E 00000DDD8|4D0f4fD ///////$1:43/0!!!3/004/N)N)N)!00 /N)! /N)N)+,PyBF"+./00+,4#4,,40),h2 JN)| < 3/3/&0!!!!4 > :  SKIN PIERCING AND TATTOOING APPLICATION CHECKLIST CHECKLISTAPPLICANT'S CHECK OFFICE CHECK1.Have either Question 1 or 2 then 3 to 11 been completed? Yes/NoYes/No2.Is the contact details completed i.e. E-mail Address and Telephone Number? Yes/No Yes/No3.Is the application form signed and dated? Yes/NoYes/No4.Is original correspondence from HMRC quoting the UTR attached? (See note 5) Yes/NoYes/No6.Is the applicant a person from abroad? (NINO issued to PFA's start with an "S"). Yes/No N/AYes/No N/A7.Has the notices been handed back to the applicant to be displayed for 21 days. Yes/NoYes/No8.Is a copy of the appropriate Certificates attached. Yes/No Yes/No9.Is a copy of the First Aid Certificate attached?Yes/No Yes/No10.Copy of Public Liability Insurance. 5 million. Yes/No Yes/No11.Have you read the privacy notice?Yes/No Yes/No12.Fee of 150 received. Yes/No Yes/No N.B EACH APPLICATION FEE ONLY INCLUDES 1 INSPECTION OF THE PREMISES IF OFFICERS NEED TO RE-INSPECT A FEE OF 50 WILL BE CHARGED FOR EACH ADDITIONAL VISIT. N.B. Is the person regulated by the Professional Standards Authority (PSA) if they are then they are exempt from having to apply for a licence. COMMENTS  CIVIC GOVERNMENT (SCOTLAND) ACT 1982 APPLICATION FOR A GRANT FOR LICENSING OF SKIN PIERCING AND TATTOOING ORDER 2006 For Official Use Only Last Date for Consideration: Date Received: Receipt No. Date to Officers: COMPLETE QUESTION 1 OR QUESTION 2 - THEN QUESTIONS 3 TO 11 MUST BE ANSWERED (ALL IN BLOCK CAPITALS) PARTICULAR ATTENTION SHOULD BE TAKEN WHEN DETAILING CONVICTIONS AND FIXED PENALTIES NB You must be over the age of 18 to carry on a business which provides skin piercing or tattooing 1. TO BE COMPLETED IF INDIVIDUAL (a)Full Name of Applicant (including middle names) Surname  FORMTEXT      First Name(s)  FORMTEXT      (b)Address Details Current Address (including postcode)  FORMDROPDOWN Please enter the date you moved to your current address FORMDROPDOWN If you have lived at this address for less than three years please state any other addresses you have resided at during this time and your period of residence at those addresses  FORMDROPDOWN (c)Date and Place of Birth FORMDROPDOWN (d)National Insurance Number (see Note 6)(e)Inland Revenue Unique Tax Reference Number (See Note 5) Commencement DateIs it Current? YES/NO(f)Daytime Telephone Number FORMDROPDOWN  (g)E-mail Address  FORMTEXT      (h)Name and Address of Next of Kin  FORMDROPDOWN (i)Driving Licence Number (See Note 7) (As per DVLA Licence) where applicable(j)Passport Number/Visa Number Country of Issue   2.TO BE COMPLETED IF COMPANY OR PARTNERSHIP (a)Full Name of Company or Partnership  FORMTEXT      (b)Company Registration Number (c)Corporation Tax Reference Number THIS IS DIFFERENT TO YOUR INDIVIDUAL NUMBER. THIS IS UNIQUE TO THE COMPANY/PARTNERSHIP.(d)Address of Principal Office (inc postcode) FORMTEXT       (e)Daytime Telephone Number FORMTEXT      (f)Full names (including middle names), private addresses (including postcode) and dates of birth of directors, partners or other persons responsible for its management  FORMTEXT      (g)Full name (including middle names), home address (including postcode and date of birth of employee to carry out day-to-day management of the business (including Business Hours Telephone Number and E-mail Address).  FORMTEXT      (h)Driving Licence Number (See Note 7) (As per DVLA Licence) where applicable3.Name (if any) and Address of premises to be licensed (If no premises are involved insert  None ). 4.Days and hours during which it is proposed to trade FORMTEXT      5.What activity do you intend to carry out? Please tick all that apply. ActivitiesDo you intend to carry out?Cosmetic Body PiercingElectrolysisTattooingTattooing (Micropigmentation) Tattooing (Microblading) AcupunctureEar Piercing 6.What knowledge, skill, training and experience in carrying out the activity do you have? (Attach any appropriate certificates which you possess)  FORMDROPDOWN 7.Have you completed a first aid course (attach any appropriate certificates)YES/NO 8.Provide details of all employees who are to be operators (attach any appropriate certificates) 9.Provide details of any self-employed operators (attach any appropriate certificates)  10.Have you been refused a similar licence in the last year?YES/NO If YES, give dates 11.Details of Public Liability Insurance (including identity of provider, policy number and amount of cover minimum 5m). A copy must also be provided. 12.Have you been convicted of any offences or have you been issued with any Fixed Penalty Notices from the Police, Fiscal or the Council? YES/NO If YES, give details below. PLEASE NOTE IN THE CASE OF AN APPLICATION IN THE NAME OF A COMPANY OR PARTNERSHIP THE CONVICTIONS OF ALL DIRECTORS OR PARTNERS MUST BE DISCLOSED AND ALL DIRECTORS OR PARTNERS SHOULD SIGN THE FORM ON PAGE 6. IF THERE ARE MORE THAN TWO PARTNERS OR DIRECTORS PLEASE CONTINUE ON A SEPARATE SHEET Details of Convictions and Fixed Penalty Notices DETAILS OF ALL CONVICTIONS AND FIXED PENALTIES (CRIMINAL AND ROAD TRAFFIC) INCLUDING ANY SPENT CONVICTIONS MUST BE GIVEN. DateCourtCrime/OffencePenalty  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       LICENSING OFFICE PRIVACY NOTE The information you have provided on this application form, and from supporting documentary evidence  where applicable  will be used by Dundee City Council (the "data controller") for the purposes of the General Data Protection Regulation and the Data Protection Act 2018 in order to process your licensing application. The Council may check information provided by you, or information about you provided by a third party such as NHS Tayside, Scottish Fire and Rescue Service, Scottish Ambulance Service and Police Scotland with other information held by us. We may also get information from those third parties or share your information with them in order to check its accuracy, prevent or detect crime, protect public funds or where required by law. In order to process your application, we will share your information in accordance with the Civic Government (Scotland) Act 1982, other licensing legislation and with relevant internal services of Dundee City Council. Please note that you should read this service specific Privacy Notice in conjunction with the Council's Full Privacy Statement which is accessible on the Council's website at:  HYPERLINK "http://www.dundeecity.gov.uk/privacy" www.dundeecity.gov.uk/privacy I declare that the particulars given by me on this form are correct to the best of my knowledge and belief. I authorise the use of all information which I have provided for the above purposes. I hereby make application to Dundee City Council for the grant or renewal of the licence applied for. DECLARATION OF CERTIFICATE OF COMPLIANCE Delete (A) or (B) as appropriate. Where declaration (A) is made a Certificate of Compliance with Paragraph2(2) of Schedule 1 to the Civic Government (Scotland) Act 1982 must be produced in due course. (See notes). (A) I declare that I shall, for a period of 21 days commencing with the date hereof, display at or near the premises so that it can conveniently be read by the public, a note complying with the requirements of Paragraph 2(3) of Schedule 1 of the Civic Government (Scotland) Act 1982. (See Note 1). Or (B) I declare that I am unable to display a notice of this application at or near the premises because I have no rights of access or other rights enabling me to do so, but that I have taken the following steps to acquire the necessary rights, namely:- (Here specify steps taken) (C) but have been unable to acquire those rights. DATA PROTECTION ACT 1998 - YOUR PERSONAL DATA Dundee City Council respects your personal information and undertakes to comply with the Data Protection Act 1998. The personal data you have provided will be used to process the application in terms of the Act stipulated on this form. Your data may be disclosed to Police Scotland and other Council departments involved in the processing of the application and elected members when considering the application. The data (with the exception of details of any convictions) will form a register which is open to public inspection. Dundee City Council is the registered Data controller. Any queries regarding the processing of your personal data by Dundee City Council should be directed to the Legal Manager on (01382) 434000. A copy of the Councils Data Protection Policy can be obtained by writing to the Legal Manager, Corporate Services, 21 City Square, Dundee DD1 3BY. I declare that the information I have given on this form is correct and complete, that I will advise you of any other changes to the above and that I agree to this information being used for benefit fraud checks as determined necessary to the Council. Signature:Name (In block capitals):Date:Applicant/Agent/Director/Partner(delete as appropriate): Signature:Name (In block capitals):Date:Applicant/Agent/Director/Partner (delete as appropriate): GUIDANCE: 1. In terms of the Civic Government (Scotland) Act 1982 a Notice in the prescribed form must be prominently displayed on the premises for a period of 21 days from the date the application is lodged with the local authority. (Copy Notice enclosed). 2. A Certificate of Compliance requires to be produced confirming that the steps at (A) or (B) on Page 3 above have been carried out. (Copy Certificate enclosed). 3. Applicants should note that if the application relates to premises the application cannot be granted unless the following conditions are met. (a) separate rooms are provided for (i) the waiting area; and (ii) the carrying out of skin piercing or tattooing (b) the waiting area has displayed a notice advising (i) that skin piercing and tattooing will not be carried out on any person under the influence of alcohol or drugs; (ii) that skin piercing will not be carried out on any child under the age of 16 unless accompanied by a person who has parental rights and responsibilities in respect of that child and who has also given their consent in writing to the skin piercing; and (iii) that tattooing will not be carried out on any person under the age of 18. (c) the room to be used for the purposes of carrying out the skin piercing or tattooing has the following facilities (i) a sink with hot and cold running water and which uses non-hand operated taps; (ii) a paper towel holder containing paper towels; (iii) a soap dispenser containing soap; (iv) a washable bench or chair with disposable paper sheet; (v) a dispenser containing alcohol solution; (vi) a waste bucket with a pedal operated lid; (vii) a sharps container for storage of needles after use; and (vii) a first aid kit; (d) the following equipment is stored and properly maintained for use on the premises (i) ultrasonic cleaners; (ii) instrument baths; and (iii) autoclaves and autoclave pouches; and (e) the premises are well ventilated and illuminated for the purposes of skin piercing and tattooing 4. Failure to have the necessary planning consent may result in a delay in the processing of your application. It is in your interests, therefore, to check with the City Development Department, Dundee House, 50 North Lindsay Street to ensure that you have the necessary planning consent and if not to make the appropriate planning application. NOTES APPLICANTS SHOULD READ THE UNDERNOTED CAREFULLY 1. False Statements Any person who in or in connection with the making of this application makes any statement which he knows 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 500. 2. Change of Address It is a condition of licence that any person who is the holder of a licence shall notify the Licensing Authority immediately on changing address. 3. Renewal of Licence No notification will be given of the expiry of any licence granted, other than at the time of grant. It is the responsibility of the Licence Holder to ensure that any application for renewal of licence is submitted prior to the expiry of the existing licence. 4. Lodging of Application This application can be lodged at the Licensing Office, 20 City Square or Dundee House, 50 North Lindsay Street, Dundee. The Licensing Office cannot accept cash payments. Card and Cheques payments are accepted. Anyone lodging a form here and wishing to pay by cash will be issued with an invoice which will have to be paid at Dundee House. Cheques can be made payable to Dundee City Council. All forms of payment can be accepted at Dundee House. The fee is 150 which is non-refundable. The application will not be considered to be lodged until the form has been signed, the fee has been paid and either Question 1 or 2 and Question 3 11 have been fully completed. Applications which are incomplete will not be accepted. 5. Unique Tax Reference Number Self employed persons must register as such with HMRC within three months of setting up this business or they may be subject to a fine. HMRC will issue a ten digit unique tax reference number that will remain with that person for life. You can register as self employed by telephoning 0300 200 3300 or by going online to  HYPERLINK "http://www.gov.uk/log-in-file-self-assessment-tax-return" www.gov.uk/log-in-file-self-assessment-tax-return. Anyone who works for another individual or company and who are not self employed ie they receive a wage and are liable to pay tax through the PAYE system need to register with the Inland Revenue but will have to submit evidence to this effect ie a payslip or P60. 6. National Insurance Number You can find this on payslipsor letters from the Department for Works & Pensions or HM Revenue & Customs. 7. Driving Licence Number DVLA Licence details are required by Police Scotland to complete background checks on the applicant. 8. The amount of Public Liability Insurance Cover must be a minimum of 5m. We may need to see proof of your identity and National Insurance Number.  CIVIC GOVERNMENT (SCOTLAND) ACT 1982 APPLICATION TO CARRY ON A BUSINESS PROVIDING SKIN PIERCING OR TATTOOING NOTICE IS HEREBY GIVEN that application has been made on to Dundee City Council for a Licence to carry on a business providing skin piercing or tattooing in respect of premises at by:- NAME AND ADDRESS DIRECTORS NAMES AND ADDRESSES (if appropriate) DAY TO DAY MANAGER ADDRESS (if appropriate) Any objections or representations in relation to the application should be made to the Head of Democratic and Legal Services, Dundee City Council, 21 City Square within 28 days of the above mentioned date. Objections or representations should be made in accordance with the following provisions, namely:- 1. 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Notwithstanding (1)(e) above, it shall be competent for a Licensing Authority to entertain an objection or representation received by them before they may take a final decision upon the application to which it relates if they are satisfied that there is sufficient reason why it was not made in the time required. 3. An objection or representation shall be made for the purposes of (1) above if it is delivered by hand within the time there specified to the Licensing Authority or posted (by registered or recorded post) so that in the normal course of post it might be expected to be delivered to them within that time. 4. Dundee City Council shall send a copy of the objection or representation to the applicant.  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