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Licensed Premises Complaint
Licensed Premises Complaint
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Complainant details
Licensed premises details
Complaint details
Supporting evidence
Complainant details
Title
First name
*
Last name
*
Address
Address line 1
*
Address line 2
Street
Locality
Town
*
County
*
Postcode
*
Telephone number
*
Alternative telephone number
Email address
*
Do you wish to remain anonymous?
*
Yes
No
Date
*