\nApplication for Licensing of Persons Carrying on the Business of Skin Treatment<\/legend>\r\n\r\n

\n\n\n\n\n\n

\r\n 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\r\n *<\/span>\r\n <\/label>\r\n

\t\t

\t\t\t\n\t\t\t skin piercing<\/label><\/div>\n\t\t

\t\t\t\n\t\t\t electrolysis<\/label><\/div>\n\t\t

\t\t\t\n\t\t\t tattooing<\/label><\/div>\n\t\t

\t\t\t\n\t\t\t acupuncture<\/label><\/div>\n<\/div>\r\n \r\n \r\n<\/div>\n

\r\n 2- Name\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n 3- Address\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n 4- Date of Birth\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n 5- Nationality\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n 6- Name (if any) and address of premises where practice will be carried on:\r\n <\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n 7- Have you ever been found guilty by a Court of any offence under the abovementioned regulations?\r\n *<\/span>\r\n <\/label>\r\n

<\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_515_container\" class=\"frm_form_field  frm_html_container form-field\"><\/div>\n<div id=\"frm_field_516_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6y8yg\" class=\"frm_primary_label\">Email Address\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_6y8yg\" name=\"item_meta[516]\" value=\"\"  data-invmsg=\"Email Address is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_514_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">I declare that:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_514-0\">\t\t\t<label  for=\"field_gv3yz-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[514][]\" id=\"field_gv3yz-0\" value=\"I am not suffering from any disease\"  data-reqmsg=\"I declare that: cannot be blank.\" data-invmsg=\"I declare that: is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> I am not suffering from any disease<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_514-1\">\t\t\t<label  for=\"field_gv3yz-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[514][]\" id=\"field_gv3yz-1\" value=\"As far as I am aware I am not a carrier of any infectious disease\"  data-reqmsg=\"I declare that: cannot be blank.\" data-invmsg=\"I declare that: is invalid\" aria-invalid=\"false\"   \/> As far as I am aware I am not a carrier of any infectious disease<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_514-2\">\t\t\t<label  for=\"field_gv3yz-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[514][]\" id=\"field_gv3yz-2\" value=\"The above particulars are true in every respect\"  data-reqmsg=\"I declare that: cannot be blank.\" data-invmsg=\"I declare that: is invalid\" aria-invalid=\"false\"   \/> The above particulars are true in every respect<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_544_container\" class=\"frm_form_field  frm_html_container form-field\">* obligatory fields<\/div>\n<div id=\"frm_field_624_container\" class=\"frm_form_field form-field  frm_left_container\">\n\t<label for=\"h-captcha-response\" id=\"field_rd9mm_label\" class=\"frm_primary_label\">Captcha\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<div  id=\"field_rd9mm\" class=\"h-captcha\" data-sitekey=\"879caca4-a4f6-4ed9-b916-562c14dbbd63\" data-size=\"normal\" data-theme=\"light\"><\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_623_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":11,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2646","page","type-page","status-publish","hentry"],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"Chris Segovia","author_link":"https:\/\/www.environmental-agency.gi\/author\/csegovia\/"},"rttpg_comment":0,"rttpg_category":null,"rttpg_excerpt":null,"_links":{"self":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2646","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/comments?post=2646"}],"version-history":[{"count":1,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2646\/revisions"}],"predecessor-version":[{"id":2647,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2646\/revisions\/2647"}],"wp:attachment":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/media?parent=2646"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}