Application for a House to House Collection Licence

Application for a House to House Collection Licence

This form can be used to apply for a house to house collection licence in pursuance of Section 2 of the House to House Collections Act 1939.
The regulations governing house to house collections are available to view here

National Exemption Order

Please contact us if you have a National exemption order by email licensing@surreyheath.gov.uk

Are you collecting on behalf of a charity as a business*

YesNo
Applicant Details
Name*

First NameLast Name
Status of applicant (e.g. Local secretary)*
If no official status, please state if you have been authorised to collect on behalf of the benefiting charity.
Email*
example@example.com
Telephone Number *
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

TownState / Province

Postcode
Business Details
Trading Name*
Contact Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

TownState / Province

Postcode
Status of applicant (e.g. Local secretary)*
If no official status, please state if you have been authorised to collect on behalf of the benefiting charity.

Expenses
Do you propose that remuneration should be paid out of the collection?*

YesNo
Following the previous financial questions please upload a financial statement detailing the tangible costs of the collections

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Who are you paying?*

to collectorsto other persons
How much are you paying? *
Will 100% of the proceeds of the collection be donated to a charity or used for charitable purposes?*

YesNo

Previous Applications
Is an application being made for licences for collections for the same purpose in other areas?*

YesNo
Please state which councils you have applied to*
Has a permit ever been refused by any Council?*

YesNo
Please specify the reason and which Council.*

Street Collections
Do you plan to promote this House to House collection at the same time as a Street collection*

YesNo
Is it desired that the accounts of this collection should be*

Combined wholly with the amount of the street collectionIn part with the amount of the street collection
Is the collection for a war charity?*

YesNo
Has the charity been registered or exempted from registration under the War Charities Act 1940?*

YesNo
Please give name of registration authority *
Date of registration or exemption*

MonthDayYear

Convictions
Have you, or any person named in or associated with this application, been convicted of any crime or offence?*

YesNo
Please provide full details of any conviction.*

Upload Supporting Documentation
Please upload a statement of charitable purpose

purpose *statement specify they are aware of their legal requirements and the agreement between the company and charity
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Declaration
I am aware that should a permit be granted to me the collection must take place in strict compliance with street collection regulations as appropriate. I am aware that it is necessary for me to submit a certified form of statement within 28 days of the collection take place. As far as you know, the information given in this application, including any supporting documents, is true and accurate.*

Ticking this box indicates you have read and understood the above declaration
Full Name*

First NameLast Name
Date*

DayMonthYear
Privacy Statement

Details of Surrey Heath Borough Council’s Privacy Notice can be found here
Should be Empty:

Charity or Fund Details