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HOUSE TO HOUSE COLLECTIONS ACT 1939 - APPLICATION FOR PERMIT

In pursuance of section 2 of the House to House Collections Act 1939, I hereby apply for a licence authorising me to promote the collection of which particulars are given below;-

Title:

Applicants Surname: ^*

Other Name(s): ^*

Address of Applicant: ^*

Name of Charity/ Fund to benefit from the collection: ^*

Particulars of Charitable purpose for which collection is to be made (full particulars should be given): ^*

Over what parts of the district is it proposed that the collection should extend? ^*

Date of proposed collection to commence: ^*

Date of proposed collection to end: ^*

Please state dates if various:

Approximately how many persons will be authorised to act as collectors in this district: ^*

Is application being made for licence of collections for the same purpose in other districts: ^*

Yes

No

Please list with which Parish/ District Council:

Has the application, or, to the knowledge of the applicant, anyone associated with the promotion of the collection been refused a licence or order under the Act or had a Licence or order revoked: ^*

Yes

No

If yes, please give particulars:

Is it proposed to promote the collection in conjunction with a street collection: ^*

Yes

No

If the collection is for War Charity, state if such charity has been registered or exempted from registration under the War Charities Act 1940, and give name of registration authority and date of registration or exemption:

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HOUSE TO HOUSE COLLECTIONS ACT 1939 - APPLICATION FOR PERMIT