Small Lottery Licence Application

Details of Society applying for registration
1. Name of society*
Address of office/head office of society
1. Address lookup
  1. Postcode*
    
    Address
  Enter the post code to find the address.
2. House name/number*
3. Street
4. Town
5. Postcode*
Contact Details
1. Email address of society*
2. Telephone number of society*
Label
1. Please state the purpose(s) for which the society is established and conducted*
2. Charity registration number
  if applicable
Has the society held an operating licence under the Gambling Act 2005 in the period of five years ending with the date of this application:*
1. Yes
2. No
Has the operating licence been revoked in the period of five years ending with the date of this application?*
1. Yes
2. No
Label
1. Please state the reasons for revocation
2. 1. Please enclose a copy of the notice if one is available
Has the society applied for and been refused an operating licence in the period of five years ending with the date of this application?*
1. Yes
2. No

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