Application for Registration of the Premises for Acupuncture,
 Cosmetic Piercing, Electrolysis, Microneedling, Semi-Permanent Skin Colouring and Tattooing
Local Government (Miscellaneous Provisions) Act 1982

Treatment(s) requiring registration: (place a tick beside relevant treatment(s)

Acupuncture    Cosmetic Piercing    Electrolysis    Tattooing    Semi-permanent     
                                                                                                                        skin-colouring
Microneedling                                                                                              

1.		Name of Premises to be Registered:........................................................................................	
2.		Address of Premises:................................................................................................................
....................................................................................Postcode..............................................
Tel:..........................................           Email:............................................................................	
3.		Full Name of Applicant.............................................................................................................	
4.		Address of Applicant (if different to above) ................................................................………..
.......................................................…………………………………………………………………
Postcode..........................................Tel:...................................................................................	
5.		List of activities to be carried out at the premises (other than those for which registration is sought) ........................................................................………...............................................................	
6.		Describe where the treatment is to be given........................................................………..........	
7.		Describe arrangements for cleansing of equipment and the sterilisation of instruments ..............................................................................................................................………………
……………………………………………………………………………………………………..........	
8.		Have you previously been registered in this respect in any other district?     Yes     No 
If yes, give details of where...........................................................................……………........	
9.		Have you ever been convicted of an offence under Regulation 13 - 17 of the Local Government (Miscellaneous Provisions) Act 1982                Yes         No 	

Date:.....................................	Signed.................................................................

Payment will be collected by debit or credit card ONLY once your application has been received. 
£247.00 for initial registration and up to 2 persons                     
£50.00 for additional person or change of person
£199.00 for change of premises
£19.50 administration charge for replacement of certificate/change of details
(Fees charged are for applications submitted between 1/4/25 - 31/3/26)