Application for a street collection

Police, Factories etc. (Miscellaneous Provisions) Act 1916

Local Government Act 1972

Please Note: This application relates to Street Collections only. There is a separate form for House to House collections.

"This Authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form within the authority for the prevention and detection of fraud. It may also share this information with other bodies administering public funds solely for these purposes."

Name

Name of applicant for the permit who will be responsible for the collection and who will sign and issue each collector's authority to collect.

Title

If Other, please specify

Surname ^*

First name(s) ^*

Designation

Address

Address and telephone number of the applicant

Prefix e.g. first floor flat.
House name/number
Street
Village/Area e.g. Scawby, Bottesford, etc.
Town
County
Post code Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.

Telephone number

Email address

(Note: on submitting your completed form, if you have provided a valid email address you will automatically receive a copy of your completed form).

Name of the charity for which the collection is being made

(i.e. the name to be displayed on the collecting box).

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Application for a street collection

Name

Address