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Licensing (Jersey) Law 1974 Self-declaration Form (Dec 2016), page 1
Moderate · 46/100Form Complexity Index

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What this form asks for

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This is an official self-declaration form required for suitability assessment under the Licensing (Jersey) Law 1974 when applying for a licence or to be registered as a manager/deputy manager of licensed premises. It collects identity details, residency history, and disclosures about convictions and Parish Hall Inquiries to help the parish and relevant authorities determine whether the applicant is a fit and proper person. The form must be signed as a legal declaration, and providing false information is an offence that may result in penalties. It is typically submitted to the Connétable of the parish where the licence application is made along with supporting documents (ID, disclosure certificate, and references).
Fillable fields49
Pages2
Sections14
Questions that depend on earlier answers11
Form Complexity IndexModerate, 46/100

The AI checks your answers before you download

17 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Application Type Selection (Licence vs Manager/Deputy) Required and Exclusive

Validates that exactly one option is selected for what the application relates to: either a licence or a manager/deputy manager of licensed premises. This is essential because downstream processing, eligibility criteria, and required supporting evidence may differ by application type. If neither or both are selected, the submission should be rejected or returned for correction before assessment begins.

Licensed Premises Name Completeness and Character Validation

Checks that the 'Name of licensed premises' field is completed and contains plausible text (not blank, not only punctuation, and within a reasonable length). The premises name is required to link the declaration to a specific licence application and location. If invalid, the form cannot be reliably matched to the correct premises and should be flagged as incomplete.

Licence Category Selection Validity (1–7) and At Least One Selected

Ensures that at least one licence category is ticked and that only valid category values (1 through 7) are selected. This matters because the category/ies determine the nature of the licensed activity and may affect suitability checks and licensing conditions. If no category is selected or an out-of-range value is present, the submission should be blocked pending correction.

Applicant Legal Name Fields Required (Surname, Forenames, Title Optional)

Validates that surname and forenames are provided and are not placeholders (e.g., 'N/A', '.', or whitespace), while allowing title to be optional. Accurate legal names are necessary for identity verification, disclosure checks, and matching to court/police records. If missing or clearly invalid, the form should be treated as incomplete and not processed.

Date of Birth Format and Plausibility Check

Checks that the date of birth is present, uses an accepted date format (e.g., DD/MM/YYYY), and represents a plausible past date (not in the future and not unreasonably old). Date of birth is a key identifier for disclosure and record matching. If the date is malformed or implausible, the submission should be rejected or routed for manual verification.

Place of Birth Required and Non-Empty

Ensures the place of birth field is completed with meaningful text (town/country or equivalent) and not left blank. Place of birth supports identity verification and helps distinguish individuals with similar names. If missing, the form should be flagged as incomplete and the applicant asked to provide it.

And 11 more checks
  • Current Address Completeness (Address Lines, Parish, Post Code)
  • Jersey Post Code Format Validation
  • Telephone Number Format and Minimum Digits
  • Email Address Syntax Validation (If Provided)
  • Previous Names Section Consistency (Nil vs Details + Change Dates)
  • Residency in Jersey for Last 3 Years: Mandatory Yes/No and Address History Alignment
  • Previous Addresses in Last 5 Years: Required Coverage or Explicit 'Nil'
  • Address Date Range Validation (Format, Order, and Non-Overlapping Logic)
  • Convictions Declaration Logic (Yes Requires At Least One Complete Offence Row)
  • Parish Hall Inquiry Declaration Logic (Yes Requires At Least One Complete Attendance Row)
  • Declaration Signature and Declaration Date Required and Valid

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How to Fill Out Licensing (Jersey) Law 1974 Self-declaration (Dec 2016) Online for Free in 2026

What the AI walks you through.

  1. Select what the application relates to (licence vs manager/deputy manager) and enter the licensed premises name and licence category/ies.
  2. Enter your personal details: full name, date/place of birth, current address, parish, postcode, and contact information.
  3. List any previous names (including maiden name), previous forenames/surnames, and the date(s) the name changed (or enter “Nil” if none).
  4. Answer the residency question for the last 3 years and provide all previous addresses for the last 5 years with the dates lived at each (or “Nil” if none).
  5. Disclose any convictions (including spent convictions as required) with dates, court, offence, and sentence, or tick “No” if none.
  6. Disclose any Parish Hall Inquiry attendance with dates, parish, reason, and Centenier decision, or tick “No” if none.
  7. Review the declaration, sign and date the form, then submit it to the relevant parish Connétable with required attachments (proof of identity, Disclosure Scotland basic disclosure certificate, and required references).

Common Mistakes in Completing Licensing (Jersey) Law 1974 Self-declaration (Dec 2016)

The ones the AI is built to catch.

Not using black ink or submitting an illegible form
People often complete the form in blue ink, pencil, or with faint handwriting, especially when filling it out quickly. This can cause scanning/photocopying issues and make key details (names, dates, addresses) unreadable, delaying processing or triggering requests to resubmit. Use black ink only, write in block capitals where possible, and avoid corrections that obscure the original text.
Failing to tick the correct application type (licence vs manager/deputy manager)
Applicants sometimes leave the “Application relates to” section blank or tick both boxes because they are unsure which applies. This creates ambiguity about what suitability assessment is being requested and can lead to the application being paused for clarification. Tick exactly one option that matches your role in the application and confirm it aligns with the main licence application being made.
Omitting or misnaming the licensed premises and licence category/ies
A common error is leaving the premises name blank, using a trading nickname that doesn’t match official records, or forgetting to tick the licence category/ies (1–7). This can prevent the parish from matching your declaration to the correct premises/licence file and may delay the Licensing Assembly process. Use the exact registered name of the premises and tick all relevant categories as held/applied for.
Incomplete personal details (DOB/POB, parish, postcode, contact details)
Applicants frequently miss required identity fields such as date of birth, place of birth, parish, or postcode, or provide an email/telephone number that is incorrect. Missing or inconsistent details make identity verification harder and can slow down follow-up questions or document matching. Double-check that all fields in Section 2 are completed and that contact details are current and legible.
Not listing all previous names or writing 'N/A' instead of 'Nil'
People often forget to include maiden names, former surnames/forenames, or they write “N/A” and omit dates of name changes. Because the form explicitly asks for all previous names and instructs you to enter “Nil” if none, missing name history can cause disclosure checks and references to fail to match your identity. List every name used (including spelling variations if relevant), include the date(s) changed, and write “Nil” only if you have never used any other name.
Misunderstanding the Jersey residency question (3 years) and answering incorrectly
Applicants sometimes answer “Yes” based on current residence, overlooking short periods living abroad or off-island within the last 3 years. An incorrect answer can lead to missing required references from other places of residence and may be treated as misleading if discovered later. Review the full 3-year period immediately before the application date and answer “No” if you lived anywhere else for any part of that time.
Incomplete address history for the last 5 years (missing dates or partial addresses)
A frequent issue is providing only one previous address, omitting move-in/move-out dates, or listing addresses without full details (house name/number, street, parish/town, postcode). This creates gaps that complicate background checks and can trigger requests for clarification. Provide every address for the last 5 years in order, with clear date ranges for each, and write “Nil” only if you truly had no previous addresses.
Not providing the required supporting documents or providing out-of-date proofs
Applicants often submit the form without all required attachments: proof of identity (passport/driving licence plus bank statement/utility bill dated within 3 months), a Basic Disclosure certificate from Disclosure Scotland, and the required reference(s) covering the last 3 years’ residence. Missing documents are one of the most common reasons applications are not progressed. Use a checklist before submission and ensure the address proof is within the last 3 months and matches the address on the form.
Incorrectly answering the convictions question or failing to include spent/foreign convictions
Some applicants tick “No” because they believe spent convictions don’t count, or they omit foreign convictions, not realizing the form requires disclosure of all offences including spent convictions under the stated Jersey regulations. This can have serious consequences, including refusal of the application and potential legal issues for false statements. If you have any convictions anywhere, tick “Yes” and provide full details for each offence, even if you think it is spent.
Providing incomplete conviction details (missing court, offence, sentence, or dates)
When applicants do disclose convictions, they often provide vague descriptions (e.g., “driving offence”) or omit the convicting court, exact offence, sentence, or conviction date. Incomplete information prevents proper assessment and usually results in follow-up requests, delaying the application. Use official paperwork (court documents or disclosure certificate) to copy the exact offence title, court name, date of conviction, and sentence imposed.
Forgetting to disclose Parish Hall Inquiries or leaving the details table blank after ticking 'Yes'
Applicants sometimes misunderstand what counts as a Parish Hall Inquiry, or they tick “Yes” but fail to complete the table with dates, parish, reason, and the Centenier’s decision. Missing inquiry details can be treated as incomplete disclosure and can delay suitability assessment. If you have attended any Parish Hall Inquiry, list each attendance separately with as much detail as possible; if none, tick “No” clearly.
Missing signature/date or signing without reviewing the false statement warning
A common final-step mistake is forgetting to sign and date the declaration, or signing while earlier sections contain blanks or inconsistencies. An unsigned/undated declaration may be invalid and returned, and inconsistencies increase the risk of being seen as providing false or misleading information. Before signing, re-check every section, ensure “Nil” is used where required, and sign and date in the spaces provided.

Frequently Asked Questions About Licensing (Jersey) Law 1974 Self-declaration (Dec 2016)

 

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You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of Licensing (Jersey) Law 1974 Self-declaration (Dec 2016), on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
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How complex is Licensing (Jersey) Law 1974 Self-declaration (Dec 2016) to fill out?
Licensing (Jersey) Law 1974 Self-declaration (Dec 2016) has a Form Complexity Index of 46 out of 100, in the moderate tier: 49 fillable fields across 2 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is this self-declaration form for under the Licensing (Jersey) Law 1974?
This form is used to assess whether you are a suitable (“fit and proper”) person to be granted a licence or to be registered as a manager/deputy manager of licensed premises in Jersey.
Who needs to complete this form?
You must complete it if you are applying for a licence, or if you are applying to be registered as a manager or deputy manager of licensed premises (or for certain roles requiring approval under the Licensing (Jersey) Law 1974).
Where do I send the completed form?
Return the completed form to the Connétable of the parish where the licence application is being made (i.e., the relevant Parish Hall for that parish).
What documents must I submit with the form?
You must include proof of identity (passport or driving licence AND a bank statement or utility bill dated within the last 3 months showing your residential address), a basic disclosure certificate from Disclosure Scotland, and references covering the last 3 years’ residence.
What counts as acceptable proof of identity and address?
Provide a passport or driving licence for identity, plus a bank statement or utility bill dated within the last 3 months that shows your current residential address.
What is the “basic disclosure certificate from Disclosure Scotland” and do I have to provide it?
It is a criminal record disclosure document issued by Disclosure Scotland. The form instructions state it must be submitted with your application.
What references do I need to provide for the last 3 years?
You must provide a reference (or references) from the place or all places where you have lived during the 3 years immediately before the application date, from a responsible official stating you are a fit and proper person to have charge of licensed premises.
How do I complete Section 1 about the licence details?
Tick whether the application is for a licence or for a manager/deputy manager role, write the name of the licensed premises, and tick the category/ies of licence held (1–7) that apply.
What should I write if I have no previous names or no previous addresses?
If you have none, the form instructs you to enter “Nil” in the relevant section.
If I have not lived in Jersey for the last 3 years, what should I do?
Tick “No” in the residency question and list your previous addresses as required. You will also need references from each place you have been resident during the last 3 years.
Do I need to disclose spent convictions or convictions from outside Jersey?
Yes. The form asks whether you have ever been convicted of any offence, including offences committed in a foreign country, and states you must provide details of each offence including spent convictions in accordance with the Rehabilitation of Offenders (Exceptions) (Jersey) Regulations 2002.
What details do I need to provide if I answer “Yes” to having convictions?
For each offence, provide the date of conviction, the convicting court, the offence, and the sentence imposed.
What is a Parish Hall Inquiry, and what if I have attended one?
A Parish Hall Inquiry is a parish-level process in Jersey. If you have attended one, tick “Yes” and provide the date, parish attended, reason for attendance, and the Centenier’s decision.
Do I have to complete the form in a specific way (e.g., ink color)?
Yes. The form instructs you to complete it in BLACK INK.
What happens if I provide false information on the form?
The declaration warns that it is an offence to make a false statement or give false information for this application, and it could result in a fine and imprisonment for up to 6 months.
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