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

If the address is within North Lincolnshire, enter the postcode in the box below and then select "find address". If the address is outside of North Lincolnshire, or your address is NOT SHOWN in the list or is incorrect, you will need to enter the address in the boxes provided below.

Postcode

Prefix

e.g. first floor flat

House number/name

Street

Town/village

County

Country

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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