Street Collections Regulation Application form

Street Collections Regulations Application for Permit
1. Police, Factories, etc (Miscellaneous Provisions) Act 1916
  
  The Charitable Collections (Transitional Provisions) Order 1974
  
  Please complete the form below and if the dates are available a Street Collection Permit will be issued to you.
  
  Please provide at least a month's notice.
  
  If there is a problem with your application we will contact you
2. Fields marked with * are required
Applicant Details
1. 1. Surname*
2. 1a. Other Names*
3. 2. Address of applicant*
4. 3. Telephone Number*
5. 4. Email Address *
Charity Details
1. 5. Particulars of charitable purposes to which proceeds of collection are to be applied. (Full particulars should be given and, where possible, the most recent account of any charity which is to benefit should, be uploaded)
2. i) Charity Name*
3. ii) Charity Address*
4. iii) Registered Charity Number
5. Recent Accounts upload
Collection Details
1. 6. Date of Collection (HH/MM/YYYY)*
2. 6a. If you require more than one date please enter the required extra dates in the box
3. 7. Area for Collections*
4. 7a. Times of Collections (HH:MM)*
5. 7b. Number of Collectors*
6. Total Collectors*
7. 8. Is it proposed to collect money?*
  
  Yes
  
  No
8. 9. Is it proposed to sell articles?*
  
  Yes
  
  No
9. Please provide the nature and price of the articles
10. 10. Is it proposed that remuneration will be paid to
11. (a) Collectors?*
12. Rate
13. (b) To other persons?*
14. Rate
15. 11. Have you, or to your knowledge, anyone associated with the Charity, been refused a permit under the Act, or had a permit revoked?*
  
  Yes
  
  No
16. Please provide details of the refusal or revocation of a permit
17. 12. Is it proposed to promote this collection in conjunction with a house to house collection?*
  
  Yes
  
  No
Declaration
1. To: Breckland Council
2. In pursuance of Section 5 of the Police, Factories etc (Miscellaneous Provisions) Act 1916, I hereby apply for a permit authorising me to promote the collection of which particulars are given above
3. I understand that by checking the declaration box below it is classed as my electronic signature and is the legally binding equivalent to my handwritten signature*
4. Full name of person completing this form*
5. Date (DD/MM/YYYY)*
Are you completing this form on behalf of someone else?*
1. Yes
2. No
Assisted service details
1. In what capacity are you completing this form?
  
  CC Staff
  
  Agent/Solicitor
  
  Relative/Friend
  
  Carer
  
  Other
2. Name of person completing this online form
3. Email of person completing this form
Privacy statement

Breckland Council is collecting this information, via this form, in order to perform this service or function, and if further information is needed in order to do so, you may be contacted using the details provided.

In performing this service, the Council may share your information with other organisations or departments, but only when it is satisfied that it is necessary to perform a public task, or to exercise its statutory duties to do so.

The Council may also share your personal information for the purposes of the prevention, investigation, detection, or prosecution of criminal offences, but will not share your personal information, or use it for any other purpose, unless provided for by law.

More detailed information about the Council's handling of your personal data can be found in our privacy policy.

Last updated: 08/05/2019 12:19:22

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Street Collections Regulation Application form

Police, Factories, etc (Miscellaneous Provisions) Act 1916 The Charitable Collections (Transitional Provisions) Order 1974

Privacy statement

Police, Factories, etc (Miscellaneous Provisions) Act 1916

The Charitable Collections (Transitional Provisions) Order 1974