Please complete this form if you want to apply for a variation to a

Colchester Borough Council
Application for Variation of a licence for a licensable
house in multiple occupation (HMO) issued under part
3 of the Housing Act 2004
Complete this form to apply for a variation to a licence for a licensable house in multiple
occupation (HMO) issued under Part 2 of the Housing Act 2004 (“the Act”). Complete the
form fully; do not leave any lines blank. A separate application must be made for every
property where a variation to a licence is needed. If you require help in completing this form,
or you require additional forms, please contact the Housing Enforcement and Inspection team
on Colchester (01206) 282840 or by email to housing.private@colchester.gov.uk
NOTE – Variation of a licence only applies to the conditions imposed by the licence.
Any request for a change of licensee requires a new application and the revocation of
the existing licence
Reference number of current licence:
MAU
Date current licence issued?
Owner’s Details:
Title:
Date of Birth
Forename(s):
Surname:
Address:
Post Code:
Telephone/Mobile:
Email/ Fax:
Section Two: Co-owner/Manager/Managing Agent Details
Title:
Date of Birth
Forename(s):
Surname:
Address:
Post Code:
Telephone/Mobile:
Email/ Fax:
Section Three: Details of licensed property
Address of property:
Post Code:
Are you the registered
owner of the property?
If “NO”, please supply
the owner’s name &
address
YES:
NO:
Post Code:
Page 1 of 4
On top right hand
corner of licence
Colchester Borough Council
Supporting information?
Please provide a detailed explanation of the variation(s) to the licence that you are
applying for. Attach additional sheets, if necessary.
NOTE:
If the Council decides to vary the licence of its own accord or, having received an application
does not agree to the variation(s) request, the applicant will be informed of:
a)
b)
c)
d)
the decision
the reason for the decision and the date on which it was made
the right of appeal against the decision
the period within which an appeal may be made
The person concerned may appeal to the Residential property Tribunal against the decision
within a period of 28 days beginning on the date that the refusal was made.
Section Four: Declaration
Note to Applicant(s):
It is a criminal offence to knowingly supply information which is false or misleading for the
purposes of obtaining a variation to a licence. If it late transpires that you have omitted any
relevant information in support of your application or you have made any false statements or
representations, the variation may be refused and other appropriate action taken.
Declaration:
I/we declare that the information contained in this application is correct to the best part
of my/our knowledge. I/we understand that I/we commit an offence if I/we supply any
information to a local housing authority in connection with any of their functions under
any of Parts 1 to 4 of the Housing Act 2004 that is false and misleading and which I/we
know to be false or misleading or I/we are reckless as to whether it is false or
misleading.
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Colchester Borough Council
I/we understand that should any circumstances referred to in this application change,
that I/we must inform Colchester Borough Council as soon as practicable. I/we
understand that the information supplied with this application will be stored in
accordance with the principals of the Data Protection Act 1998 and will only be shared
with other relevant bodies, including other local authorities and Government Agencies,
where legally necessary.
I/we enclose payment of a fee of £150 for variation of HMO licence
Signed: ________________________________________
Date: _________________
Print Name: ____________________________________
Signed: ________________________________________
Date: _________________
Print Name: ____________________________________
Signed: ________________________________________
Date: _________________
Print Name: ____________________________________
Signed: ________________________________________
Date: _________________
Print Name: ____________________________________
In the case of partnerships or trusts, all partners/trustees must sign. In the case of a
limited company this application must be signed by a Director or Company secretary
or other authorised officer, in which case proof of authorisation may be required.
Return this form to:
Housing Enforcement and Inspection Team
Colchester Borough Council
33 Sheepen Road
Colchester
CO3 3WG
Tel: Colchester (01206) 282840
Please see notes overleaf.
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Colchester Borough Council
In accordance with the Housing Act 2004 please note the following:
Section 238 – False or misleading information
(1) A person commits an offence if –
(a) he supplies any information to a local housing authority in connection with any
of their functions under any of Part 1 to 4 or this Part of the Act.
(b) the information is misleading, and
(c) he knows that it is false or is misleading or is reckless as to whether it is false
or misleading.
(2) A person commits an offence if (a) he supplies any information to another person which is false or misleading,
(b) he knows that it is false or misleading or is reckless as to whether it is false or
misleading, and
(c) he knows that the information is to be used for the purpose of supplying
information to a local housing authority in connection with any of their
functions under any of Parts 1 to 4 or this Part of the act.
(3) A person who commits an offence under subsection (1) or (2) is liable on summary
conviction to a fine not exceeding level 5 on the Standard Scale.
(4) In this section “false or misleading” means false or misleading in any material
respect
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