LICENCE APPLICATION / RENEWAL FORM First Name *Surname *Club/ ClassDate of Birth *Mobile *Gender *MaleFemaleAddressCityPost CodeEmail Address *Last Grading Date:Place of Grading:Grade Awarded:Previous Licence Expiry Date:Previous Licence Serial Number:Signature of the Club Instructor:Choose FileNo file chosenDelete uploaded fileDateApplicant’s Signature:Choose FileNo file chosenDelete uploaded file(Signature of the Parent/Guardian if applicant is under 18 Years) *A surcharge of £5-00 is applicable for all renewal applications made after the expiry date.Date Submit LICENCE APPLICATION / RENEWAL FORM
