Application to hold a fireworks display during night hours

Applicants Details

Name of Applicant

Title

First Name(s)

Surname

Address of Applicant

Address

Address 2

City/Town

Post Code

Applicant's Business Telephone number

Applicant's Mobile Number

Applicant's Email Address

Event Details

Name of Person for whom the event is being run

Title

First Name(s)

Surname

Address of person for whom the event is being run

Address

Address 2

City/Town

Post Code

Date of display for which dispensation is required

Name of person in charge of firing the display

Title

First Name(s)

Surname

Telephone number on which this person can be contacted

Description of event in respect to which this application is made

Location of event

Time at which event is due to start

Time at which event is due to end

Time at which use of fireworks will begin

Time at which use of fireworks will end

Description of firework display

Description of all firework effects to be used during display

Where are fireworks to be kept immediately prior to use

Distance between nearest residential building and point at which fireworks will be used

MSER Registration / Licence Number

Name of MSER Licencing Authority

Declaration and Information

I confirm that I or the person by whom I am employed is a professional organiser of firework displays

I or the person by whom I am employed holds Public Liability Insurance in respect to the use of fireworks at this event

I confirm that the use of fireworks for which this dispensation is sought is at a national public celebration or national commemorative event

Yes

Submitted by

Position

Please note that your application will be submitted to Police Scotland as part of the consultation process and that Community Councils and other representative bodies may also be consulted about your application. Your application form will also be included in the documents sent to members of the relevant Area Committee and as such will become a public document.

The information you supply on this form will be used for the purpose for which you have provided it, and appropriate measures are in place to protect your personal data. A full privacy notice, which provides information about your rights under current data protection legislation and details about what will happen to your personal data can be found here:

Privacy Notice - Fireworks displays

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Application to hold a fireworks display during night hours

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