Application Registration Form For Acupuncture, Tattooing, Semi-Permanent Skin Colouring, Cosmetic Piercing Or Electrolysis

Local Government (Miscellaneous Provisions) Act 1982 Application For Registration To Carry On The Practice Of Acupuncture Or The Business Of Tattooing; Of Cosmetic Piercing; Of Semi-Permanent Skin Colouring Or Of Electrolysis

Please enter full name & address of applicant

Title *

Entries with a red asterick must be filled in

First Name

Surname *

Address Line 1 *

Address Line 2

Address Line 3

Postcode *

Telephone Number

E-mail Address

Address of premises required to be registered

Business Address Line 1 *

Business Address Line 2

Business Address Line 3

Postcode *

Telephone Number

Have you ever been convicted of an offence under Section 16 of the above Act? If 'Yes', give details

Yes

Type of registration required

Where more than one activity is to be undertaken the sum total of each registration is the fee to be enclosed.

Please select the relevant box(es). *

ACUPUNCTURE Person £66.50
ACUPUNCTURE Premises £87.00
COSMETIC PIERCING Person £66.50
COSMETIC PIERCING Premises £87.00
TATTOOING Person £66.50
TATTOOING Premises £87.00
ELECTROLYSIS Person £66.50
ELECTROLYSIS Premises £87.00
SEMI-PERMANENT SKIN COLOURING Person £66.50
SEMI-PERMANENT SKIN COLOURING Premises £87.00

Please enter details of qualifications and experience

I apply for registration to carry out the practice/business specified above.

I understand that the registration permits me to operate within the area of North East Lincolnshire Council on premises which are duly registered for that purpose.

I enclose a cheque/postal order made payable to 'North East Lincolnshire Council' for

Is a receipt required?

Yes

If Yes, to which address?

Applicant Address

Business Address

Signed	Dated
Signed	Dated Month Day Year

Please use the Submit button to generate the PDF and then print out the form. Sign the form and return together with said fee to the following address;

Environmental Services, Origin One, Origin Way, Genesis Europarc, Grimsby, North East Lincolnshire, DN37 9TZ

For any queries please telephone (01472) 324500 or e-mail to CustomerRequests@nelincs.gov.uk

eForms by AchieveForms

N.B! This feature uses cookies and may not function as expected if you have disabled cookies in your web browser. If you have not disabled cookies in your browser but do not want cookies to be saved to your computer, please do not use this function.

A to Z of Council Services:

A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
0 - 9