Form Of Application By A Person To Have His Name Entered In The Councils List Of Persons Entitled To Sell Non-Medical Poisons Included In Part II Of The Poisons List

Please accompany the form with a cheque made payable to North East Lincolnshire Council for the appropriate fee *(see Note 4 below) to:

North East Lincolnshire Council, Trading Standards Service, Origin One, 1 Origin Way, Europarc, Grimsby, DN37 9TZ.

Please use the Add button for supplying additional partners details (see Note 1)Please use the Add button for supplying additional partners details (see Note 1)
I*, (see Note 1 below)
I*, (see Note 1 below)

hereby apply to have my name entered in the list kept in pursuance of section 5 of the above Act in respect of the following premises, namely, * (see Note 2 below)
Please use Add button to list other addresses (see Note 2)Please use Add button to list other addresses (see Note 2)
as a person entitled to sell from those premises non-medicinal poisons included in Part II of the Poisons List.
I hereby nominate * (see Note 3 below)
Use Add button for details of additional deputy(ies)Use Add button for details of additional deputy(ies)
to act as my deputy (deputies) for the sale of non-medicinal poisons in accordance with Rule10(1) of the Poisons Rules 1982.

Please now select the Submit button and send the signed application with appropriate fee to the address at the top of the form. Thank you.


Note 1: The full First Name(s) and Surname of the applicant should be stated.  In case of partnership, please show the names of the partners separately, followed by the trading name.  If the applicant is a body corporate the registered name of the Company should be stated and the form should be signed by a responsible person on behalf of the Company.

Note 2: The address of each set of premises at which Part II Poisons are to be sold should be stated. 

Note 3:  Full First Name(s) and Surname of deputies permitted to sell should be stated. Not more than two deputies may be nominated in respect of each premises. The names of the owner or partner(s) should not be given as deputies.

Note 4:

Fee: The following fees shall be paid to the local authority:

(a) in respect of each new entry or change of a persons name in the list, a fee of £29.33 for each premises on which that person is entitles to sell;

(b) in respect of the making of any alteration in the list in relation to the premises on which a listed person is entitles to sell, a fee of £7.90

(c) in respect of the retention of a name on the list in any year subsequent to the year in which it was first entered, a fee of £15.47 for each premises.

Note: A change in the name of a Deputy (Deputies) incures no extra fee.

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