<p> SC1</p><p>Entertainment Licensing, Leeds City Council, Civic Hall, Leeds, LS1 1UR</p><p>Application for permission to hold a street collection within the area of Leeds City Council</p><p>PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST</p><p>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.</p><p>You may wish to keep a copy of the completed form for your records.</p><p>1. Applicant Details</p><p>Other title Mr Mrs Miss Ms (for example, Rev)</p><p>Surname First names</p><p>Please tick yes</p><p>Date of birth (dd/mm/yy)</p><p>Place of birth</p><p>Home address</p><p>Post Town Postcode</p><p>Daytime contact telephone number</p><p>Email address (optional)</p><p>2. Leeds Branch Details</p><p>Address</p><p>Post Town Postcode 3. Head Office Details</p><p>Address</p><p>Post Town Postcode</p><p>Charity Registration Number</p><p>4. Dates of Collection</p><p>First preference date</p><p>Second preference date</p><p>Third preference date</p><p>Proposed hours of collection</p><p>Total number of collectors</p><p>5. Proposed Areas of Collection</p><p>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.</p><p>AREA NO. AREA NO. AREA NO REQ. COLL REQ. COLL REQ. COLL</p><p>ABERFORD FARTOWN OTLEY </p><p>ADEL GARFORTH OULTON </p><p>ALLERTON BYWATER GILDERSOME POOL IN WHARFEDALE</p><p>ALWOODLEY GIPTON PUDSEY</p><p>ARDSLEY- GREAT & LITTLE RAWDON EAST/WEST PRESTON</p><p>ARMLEY GUISELEY ROBIN HOOD</p><p>ARTHINGTON HALTON RODLEY</p><p>BARDSEY HAREHILLS ROTHWELL </p><p>BARWICK-IN-ELMET HAREWOOD ROUNDHAY</p><p>BEESTON HEADINGLEY SCARCROFT</p><p>BELLE ISLE HOLBECK SHADWELL </p><p>BOSTON SPA HOLT PARK STANLEY </p><p>BRAMHOPE HORSFORTH STANNINGLEY</p><p>BRAMLEY HUNSLET SWILLINGTON</p><p>BURMANTOFTS KIPPAX TEMPLE NEWSAM</p><p>CALVERLEY KIRKSTALL THORNBURY </p><p>CARLTON LEDSHAM THORNER CHAPEL ALLERTON LEDSTON THORPE </p><p>CHAPEL TOWN LINTON THORPE ARCH</p><p>CHURWELL LOFTHOUSE TINGLEY</p><p>CLIFFORD LOWTOWN WETHERBY </p><p>COLLINGHAM MEANWOOD WHINMOOR</p><p>COOKRIDGE MENSTON WHITE CROSS</p><p>CROSSGATES METHLEY WHITKIRK </p><p>DRIGHLINGTON MICKLEFIELD WIKE </p><p>EAST KESWICK MIDDLETON WOODLESFORD</p><p>FARNLEY MORLEY WOODHOUSE</p><p>FARSLEY MOORTOWN WORTLEY </p><p>OAKWOOD YEADON </p><p>Other area(s) not on list ______</p><p>6. Leeds City Centre Collections Only: </p><p>Please state the streets on which you wish to collect in the City Centre:</p><p>In the case of City Centre collections, is it your intentions to sell articles for the benefit Yes/ No charitable purposes?</p><p>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.</p><p>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?</p><p>In the case of City Centre collections, is it your intentions to site any vehicle in Yes/ No association with the collection?</p><p>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.</p><p>7. Expenses </p><p>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:</p><p>To what purpose do you propose to allocate the proceeds of collection? (After expenses if any):</p><p>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:</p><p>Has the applicant previously held a Street Collection Permit with this Authority on behalf Yes/ No of any other organisation:</p><p>Should the answer to the above be YES, please provide the name and address of the organisation and date of collection:</p><p>Has the applicant previously held a Street Collection Permit with this Authority on behalf Yes/ No of any other organisation:</p><p>8. Collections held in conjunction with an event</p><p>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.</p><p>PLEASE NOTE THAT THE LEEDS CITY COUNCIL MAY ONLY GRANT PERMISSION TO COLLECTIONS HELD WITHIN THE LEEDS BOUNDARY</p><p>Please answer the following questions:</p><p>Are West Yorkshire Police aware of this event? Yes/ No</p><p>Has permission been obtained from the West Yorkshire Police Yes/ No</p><p>From which Police Station(s) was permission granted? Yes/ No Name(s) of Police Officer(s) from whom permission was obtained:</p><p>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</p><p>Signature of applicant</p><p>Signature</p><p>Date</p><p>Capacity</p><p>Contact name and address for correspondence associated with this application</p><p>Post town Post code</p><p>Telephone number (if any)</p><p>If you would prefer us to correspond with you by e-mail, your e-mail address (optional)</p><p>Please return this completed application form together with associated documentation to Entertainment Licensing, Civic Hall, Leeds, LS1 1UR.</p><p>For further assistance please do not hesitate to contact us on 0113 378 5029</p>