Small Lotteries Licence

Type of application

New Application

Renewal

Section A - Details of society applying for Registration

Name of society

Address of office or head office of society

Address

Address 2

City/Town

Post Code

Country

Telephone number of society

Please state the purpose(s) for which the society is established and conducted

If the society is a registered charity, please give the society’s unique charity registration number

Has the society held an operating licence in the period of five years ending with the date of this application

Yes

Has the operating licence been revoked in the period of five years ending with the date of this application

Yes

Please state the reasons for revocation

Please enclose a copy of the notice of revocation

One file only.
64 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, rtf, pdf, doc, docx, xls, xlsx.

Has the society applied for/been refused an operating licence in the period of five years ending with the date of this application

Yes

SECTION B – General information about person applying on behalf of society

Name

Title

First Name(s)

Surname

Date of Birth

Capacity

Address

Address 2

City/Town

Post Code

Daytime telephone number

E-mail

SECTION C – Contact details for correspondence associated with this application

Please advise whether the address in Section A, B, or an alternative address should be used in respect of correspondence

Section A address

Section B address

New Address

Other address

Address

Address 2

City/Town

Post Code

Telephone number

Email address

SECTION D – Declaration

I (please state your full name)

make this application on behalf of the society referred to in Section A and have authority to act on behalf of that society;
submit the appropriate registration fee with my application: £40.00 for a new application, £20.00 for a renewal.
confirm that, to the best of my knowledge, the information contained in this application is true. I understand that it is an offence under section 342 of the Gambling Act 2005 to give information which is false or misleading in, or in relation to, this application;

Capacity

Note to societies applying for registration:

The application will be refused if in the period of five years ending with the date of the application:

an operating licence held by the society has been revoked under section 119(1) of the Gambling Act 2005; or
an application for an operating licence made by the society has been refused.

The application may be refused if the local authority think that:

the society is not a non-commercial society;
a person who will or may be connected with the promotion of the lottery has been convicted of a relevant offence; or
information provided in or with the application is false or misleading.

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