Consent of premises licence holder to transfer

Replace the text in square brackets [ ] with your own information

I/we, [full name of premises licence holder(s)], the holder(s) of premises licence number [insert premises licence number] relating to [name and address of premises to which the application relates], give my consent for the transfer of this premises licence number to [full name of transferee].

Signature: 
Name (please print): 
Date: