Author: cassidy
Last saved by: Ross Morgan (Solihull MBC)
Company: Solihull MBC

A separate form should be completed for each person to be registered

Application for Registration of Persons to carry out Acupuncture,
Cosmetic Piercing, Electrolysis, Microneedling, Semi-permanent skin-colouring and Tattooing

Local Government (Miscellaneous Provisions) Act 1982

Treatment(s) to be carried out:        (place a tick beside relevant treatments)

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

Microneedling
About the business

1.

Business Name & Address (at which the treatments are to be carried out) ..................…………...............................
...........................................................................................…………………………………………………..Postcode..........................................………..Tel:........................................………………………………...

2. | Full name of Applicant.......................................................................................……………………….......

3.

Head Office Address (if different from above)…………………………..................………………........................
.............................................................…………………………………………………………………...…….Postcode..............................................Tel:........................................……………………………………....

About the person offering treatment

1.

Full Name (if different from above)
...........................................................................................................................…………………………....

2.

Home Address..................…............................................................................…………………….……….
................................................................Postcode...................................................………………………
Tel:......................................................Email:.......................................................................……...……….

3.

Describe where the treatment is to be given (if other than a registered premises)..........................…….................
..............................................................................................................................………………………….

4.

Describe arrangements for cleansing of equipment and sterilisation of instruments.................................
..............................................................................................................................………………………….
........................................................................................................................………………………….......

5.

What qualifications/experience do you have to carry out this treatment......…………..............................
........................................................…………...........................(Copies of certificates must accompany this application)

6. | 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. 

Please forward your completed form to pprotection@solihull.gov.uk Alternatively post to:
Food & Safety, Regulatory Services.  Solihull MBC,  The
Council House, Solihull, B91 3QB. Tel: 0121 704 8018

£235.00 for initial registration and up to 2 persons
£47.50 for additional person or change of person
£190.00 for change of premises
£18.50 administration charge for replacement of certificate/change of details
(Fees charged are for applications submitted between 1/4/24 - 31/3/25)

1
 01/04/24