SC1 - Street Collection Application Form

Entertainment Licensing, Leeds City Council, Civic Hall, Leeds, LS1 1UR

Application for permission to hold a street collection within the area of Leeds City Council

PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST

Before completing this form please read the guidance notes at the end of the form. If you are completing this form by hand please write legibly in block capitals. In all cases ensure your answers are inside the boxes and written in black ink. Use additional sheets if necessary.

You may wish to keep a copy of the completed form for your records.

1. Applicant Details

Other title Mr Mrs Miss Ms (for example, Rev)

Surname First names

Please tick yes

Date of birth (dd/mm/yy)

Place of birth

Home address

Post Town Postcode

Daytime contact telephone number

Email address (optional)

2. Leeds Branch Details

Address

Post Town Postcode 3. Head Office Details

Address

Post Town Postcode

Charity Registration Number

4. Dates of Collection

First preference date

Second preference date

Third preference date

Proposed hours of collection

Total number of collectors

5. Proposed Areas of Collection

Please tick the box next to the relevant area(s) in which you intend to collect and indicate the number of persons who will be collection in that area. In the event of a collection to be held in conjunction with a bed push or similar event, please refer to overleaf.

AREA NO. AREA NO. AREA NO REQ. COLL REQ. COLL REQ. COLL

ABERFORD FARTOWN OTLEY

ADEL GARFORTH OULTON

ALLERTON BYWATER GILDERSOME POOL IN WHARFEDALE

ALWOODLEY GIPTON PUDSEY

ARDSLEY- GREAT & LITTLE RAWDON EAST/WEST PRESTON

ARMLEY GUISELEY ROBIN HOOD

ARTHINGTON HALTON RODLEY

BARDSEY HAREHILLS ROTHWELL

BARWICK-IN-ELMET HAREWOOD ROUNDHAY

BEESTON HEADINGLEY SCARCROFT

BELLE ISLE HOLBECK SHADWELL

BOSTON SPA HOLT PARK STANLEY

BRAMHOPE HORSFORTH STANNINGLEY

BRAMLEY HUNSLET SWILLINGTON

BURMANTOFTS KIPPAX TEMPLE NEWSAM

CALVERLEY KIRKSTALL THORNBURY

CARLTON LEDSHAM THORNER CHAPEL ALLERTON LEDSTON THORPE

CHAPEL TOWN LINTON THORPE ARCH

CHURWELL LOFTHOUSE TINGLEY

CLIFFORD LOWTOWN WETHERBY

COLLINGHAM MEANWOOD WHINMOOR

COOKRIDGE MENSTON WHITE CROSS

CROSSGATES METHLEY WHITKIRK

DRIGHLINGTON MICKLEFIELD WIKE

EAST KESWICK MIDDLETON WOODLESFORD

FARNLEY MORLEY WOODHOUSE

FARSLEY MOORTOWN WORTLEY

OAKWOOD YEADON

Other area(s) not on list ______

6. Leeds City Centre Collections Only:

Please state the streets on which you wish to collect in the City Centre:

In the case of City Centre collections, is it your intentions to sell articles for the benefit Yes/ No charitable purposes?

If the answer to above is `Yes' you will require permission from the Development Department Asset Management Division, Markets Services, 34 George Street, Leeds, LS2 7HY, Telephone 0113 2145162 Fax 0113 2135177.

In the case of City Centre collections, is it your intentions to site any trestle table, display Yes/ No unit or vehicle in association with the collection?

In the case of City Centre collections, is it your intentions to site any vehicle in Yes/ No association with the collection?

If the answer to above is `Yes' you must receive authorisation from the City Centre Management Office, which is located at Leonardo Building, 2 Rossington Street, Leeds, LS2 8HD - Telephone number 2474471.

7. Expenses

What percentage of proceeds collected do you propose to allocate to expenses, if any? Please provide a brief explanation of the expenses to be deducted:

To what purpose do you propose to allocate the proceeds of collection? (After expenses if any):

If a branch of a national charity, specify proportion to be allocated to this area and specify purpose to which the proceeds will be allocated:

Has the applicant previously held a Street Collection Permit with this Authority on behalf Yes/ No of any other organisation:

Should the answer to the above be YES, please provide the name and address of the organisation and date of collection:

Has the applicant previously held a Street Collection Permit with this Authority on behalf Yes/ No of any other organisation:

8. Collections held in conjunction with an event

Should the street collection be in conjunction with a bed push or similar event, please enclose a plan of the route, together with times of departure, arrival etc.

PLEASE NOTE THAT THE LEEDS CITY COUNCIL MAY ONLY GRANT PERMISSION TO COLLECTIONS HELD WITHIN THE LEEDS BOUNDARY

Please answer the following questions:

Are West Yorkshire Police aware of this event? Yes/ No

Has permission been obtained from the West Yorkshire Police Yes/ No

From which Police Station(s) was permission granted? Yes/ No Name(s) of Police Officer(s) from whom permission was obtained:

THIS APPLICATION FORM MUST BE ACCOMPANIED BY A LETTER FROM THE GOVERNING BODY OF THE ORGANISATION AUTHORISING YOU TO HOLD A STREET COLLECTION PERMIT ON THEIR BEHALF

Signature of applicant

Signature

Capacity

Contact name and address for correspondence associated with this application

Post town Post code

Telephone number (if any)

If you would prefer us to correspond with you by e-mail, your e-mail address (optional)

Please return this completed application form together with associated documentation to Entertainment Licensing, Civic Hall, Leeds, LS1 1UR.

For further assistance please do not hesitate to contact us on 0113 378 5029