Application for a New Lottery Licence

Please use this form to apply for a new lottery application. You will need to arrange payment in addition to filling this form in.

If you are unable to use this form, please see our Contact Us (this link opens in a new window) for ways of getting in touch

Red asterisk denotes a required answer.

As part of this application, a £40 fee will need to be paid. This can be done by coming into one of our offices and making payment or by calling us on 01992 531503. Until payment has been taken, a licence will not be issued

How do you intend to make payment once this form is completed?

EAST HERTS DISTRICT COUNCIL

Gambling Act 2005 - APPLICATION FOR REGISTRATION

Title

First Name

Last Name

Your Address

City/Town

Postcode

Position held in Society (e.g. Chairman, Secretary etc)

Email address

Phone Number

Society Details

Name of Society

Is the above address the same as the address of the society?

Society Address

Address

City/Town

Postcode

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

Please outline the purpose(s) of the Society

Charitable purposes

Participation in or support of athletic sports or games or cultural activities

Purposes which, are not described above, and are neither for private gain or any commercial undertaking

Declaration

I herby apply for and on behalf of the following within the District of East Herts, for the registration of the Society for the purposes of Section 5 of the Lotteries and Amusements Act 1976.

I agree

I further declare that to the best of my knowledge and belief that no person has been convicted of an offence committed in connection with a lottery promoted or proposed to be promoted on behalf of the said Society, namely, offences under:- Sections 2, 13, or paragraph 14 of Schedule 1, of the Lotteries and Amusements Act 1976; Sections 42 or 45 of the Betting, Gaming and Lotteries Act 1963, or an offence involving fraud or dishonesty.

I agree to this statement

For the purposes of current data protection laws the information you supply the Council as part of your application will be used for the purposes of dealing with your request and retained as per our published corporate data protection privacy policy which can be found on the East Herts District Council Data Protection page (this link opens in a new window).

From time to time this information may be shared with other Council departments and / or outside partners to process your request as effectively as possible. Please confirm you have read the above privacy notice

I confirm I have read this privacy notice