Application for Artistic Licence
(all details will be treated in strictest confidence under the terms of the Artists' Data Protection Act 1983) Fill in all fields and sign the declaration. Note that knowingly omitting or falsifying any details may render you liable to attack from large men armed with blunt instruments. please return completed form to: Department of Artistic Security (formerly Lord Chamberlain's Office) Cato House Bowdler Way Cardiff CF15 6XP Tel: 0870 6666363 Fax: 029 1036 6066 Our ref: 6663XP/LO Your Artistic Security Officer is: Arnold Spratwarbler |
Name: Dai Lowe
Address: 24 Wentworth Mansions Keats Grove London NW3 2RL Fax: none Mobile: none E-mail: dai@lucidity.ltd.uk Date of Birth: 20/10/1952 Place of Birth: Boston, Lincs Nationality: Any Mother's maiden name: Levy Driving Licence: None Bank details: Bank: I keep all my cash Sort Code: in a high-interest Account No: sock under my bed! Passport No: 89672226 NI number: XY 45 12 77 V Prior convictions: completely without convictions |