APPLICATION FORM FOR REGISTRATION OF NON-COMMERCIAL SOCIETY

APPLICATION FORM FOR REGISTRATION OF NON-COMMERCIAL SOCIETY

This form is prescribed by regulation 3(1)(a) of the small society Lotteries(Registration of Non-Commercial Societies) Regulations 2007
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:

(a) an operating licence held by the society has been revoked under section 119(1) of the Gambling Act 2005, or

(b) a person who will or may be connected with the promotion of the lottery has been convicted of a relevant offence, or

(c) information provided in or with the application is false or misleading
SECTION A – Details of society applying for registration
Name of authority*
Name and address of relevant local authority – this is the local authority for the area in which the principle premises of the society are situated]
Name of society *
Address of office or head office of society*

Street Address

Street Address Line 2

TownState / Province

Postcode
Telephone number of society *
Please enter a valid phone number.
Please state the purpose(s) for which the society if established and conducted *
Is the society a registered charity*
Unique charity registration number*
Has the society held an operating licence under the Gambling Act 2005 in the period of five years ending with the date of this application?*
Has the operating licence been revoked in the period of five years ending with the date of this application?*
Please state the reasons for revocation and enclose a copy of the notice of revocation if one is available*
Has the society applied for and been refused an operating licence in the period of five years ending with the date of this application?*
SECTION B – General information about person applying on behalf of society
Name*

First NameLast Name
Capacity*
Address*

Street Address

Street Address Line 2

TownState / Province

Postcode
Daytime telephone number *
Please enter a valid phone number.
SECTION C – Contact details for correspondence associated with this application
Please tick one box as appropriate to indicate address for correspondence in relation to this application:*
Address*

Street Address

Street Address Line 2

TownState / Province

Postcode
Email address (if the applicant is happy for correspondence in relation to this application to be sent via email) *
example@example.com
SECTION D – Declaration

When you have completed this section you will be redirected to a payment URL to pay the fee of £40.00
Declaration*

I make this application on behalf of the society referred to in Section A and have authority to act on behalf of that society.Confirm that, to the best of my knowledge, the information contained in this application is true. I understand that it is an offence undersection 342 of the Gambling Act 2005 to give information which is false or misleading in, or in relation to, this application.I confirm I will pay the online fee of £40.00 fee when redirected to the payment URL on submission of this form.
Name*

First NameLast Name
Date*

DayMonthYear
Date
Capacity*
Should be Empty:

APPLICATION FORM FOR REGISTRATION OF NON-COMMERCIAL SOCIETY

SECTION A – Details of society applying for registration

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

SECTION C – Contact details for correspondence associated with this application

SECTION D – Declaration