Application for Licensing of Persons Carrying on the Business of Skin Treatment

1- In pursuance of regulation 3 of the Skin Treatments (Licensing and Control) Regulations, I hereby apply for a licence to carry on the business of *

skin piercing

electrolysis

tattooing

acupuncture

2- Name *

3- Address *

3- Address

City

State/Province

Zip/Postal

Country

4- Date of Birth *

5- Nationality *

6- Name (if any) and address of premises where practice will be carried on:

City

State/Province

Zip/Postal

Country

7- Have you ever been found guilty by a Court of any offence under the abovementioned regulations? *

Email Address

I declare that: *

I am not suffering from any disease

As far as I am aware I am not a carrier of any infectious disease

The above particulars are true in every respect

* obligatory fields

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