KIRKLEES COUNCIL
APPLICATION FOR PERMIT FOR STREET COLLECTION
IN STREETS AND PUBLIC PLACES
PARTICULARS OF COLLECTION

Completed applications must be received at least 10 working days prior to the collection, as applications received within this period may not be processed.

1	Full name of Applicant:	Mr/Mrs/Miss	
2
	Full address of Applicant:

	
	Post code:		Tel No.		
	e-mail address		DOB		
3	Society or Charity Details	
	Name of Society or Charity		
	Address

	
	Post code:		Tel No.		
	Registered Charity No.		
	A letter of authority to collect on behalf of the Charity must be submitted before we can grant your permit.  Has one been submitted previously authorising you specifically?	Yes/No	
	Have you submitted the Form of Statement from previous collections?  
If No please submit any outstanding returns with this application.	Yes/No	
4	In which town in the Kirklees area is it proposed that collections should be made:		
	What date(s) is it proposed that the collection should be made:		
	Between what times do you intend to undertake the collection?	                   to	
	If the first choice is unavailable please give an alternative date(s):		
6	Do you wish consideration to be given to park any caravan, display vehicles or erect a table or display?	Yes/No	
	If yes, please state location:		
	Type of display:		
	Vehicle Registration No.		
	Please provide photographs of the Caravan/vehicle/gazebo to be used 	
7	How many Collectors are you proposing to authorise?		

Checklist	Tick if enclosed	
A letter of authority to collect on behalf  of the Society or Charity		
Previous collection returns if not previously submitted		
Photographs of Caravan/vehicle/gazebo to be used		

Signed:		Name:		
Position in Society:		Date:		

Privacy Notice 

We have recently updated our Privacy Notice about how we use personal data provided to the Council. Further information can be found at:
http://www.kirklees.gov.uk/beta/information-and-data/pdf/privacy-notice-licensing-gambling-act.pdf

This application should be returned to:
Licensing Department
Kirklees Council
Flint Street Depot
Flint Street
Huddersfield
HD1 6LG
Tel: 01484 456868 

PLEASE NOTE - YOU MAY BE REQUIRED TO PROVIDE DOCUMENTS TO THE COUNCILS DUTY ENFORCEMENT OFFICERS ON THE DAY(S) OF COLLECTION