FOREST HEATH DISTRICT COUNCIL

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House to House Collections
Application for licence
In pursuance of Section 2 of the House to House Collections Act 1939, I hereby apply
for a licence authorising me to promote a collection, particulars of which are given
below.
1. Name and Address of Applicant
Daytime telephone number
2. Name of the charity or fund on whose
behalf the collection is to be made.
3. Address and telephone number of the
charity or fund.
4. Charity Registration Number
5. Particulars of charitable purposes to
which proceeds of collection are to be
applied. (Full particulars should be
given and, if possible, the most recent
account of any charity which is to
benefit should be enclosed)
6. Date(s) requested for the collection.
7. Locality requested for the collection.
8. Is it proposed to collect money?
9. Is it proposed to sell articles?
If so, of what nature and price.
(This does not refer to flags or
emblems).
10.Approximately how many persons is it
proposed to authorise to act as
collectors?
11.Is it proposed that remuneration
should be paid out of the proceeds of
the collection?
(a) to collectors?
(b) to other persons?
If so, at what rates and to what
classes of person?
12.Is application being made for licences
for the same purpose in other areas?
If so, to which authority?
Approximately how many persons in
all is it proposed to authorise to act as
collectors?
14.Have you or the Charity on whose
behalf you are making this application,
ever been refused a House to House
Collection Permit?
If yes, please supply details of date
and the name of the Council.
Signature of person making this application:-……………………………………………………………..
Name (in capitals)…………………………………………………….…………….
Date…………………………………………………..
Forest Heath District Council 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 for the prevention and detection of fraud. It may also share this
information with other bodies responsible for auditing or administering public funds for these purposes.
This form should be returned to :
Licensing
Forest Heath District Council
District Offices
College Heath Road
Mildenhall
Suffolk IP28 7EY
Tel: 01638 719000
Email: [email protected]
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