Street Collections
Application for permit /

In pursuance of Section 5 of the Police, Factories, etc (Miscellaneous Provisions) Act 1916, as amended by Section 251 and Schedule 29 to the Local Government Act 1972, I hereby apply for a permit authorising me to promote a street collection within St Edmundsbury for the benefit of charitable purposes.

  1. Name and Address of Applicant
Daytime tel. No:
  1. Name of the charity or fund on whose behalf the collection is to be made.

  1. Address and telephone number of the charity or fund.

  1. Charity Registration Number

  1. Date requested for the collection.

  1. Start time & finish time of the collection

  1. Locality requested for the collection – state town or village and street/area of larger towns

  1. Is it proposed to collect money?

  1. The method to be adopted in making the collection.

  1. Is it proposed to sell articles?
If so, of what nature and price.
(This does not refer to flags or emblems).
  1. Number of collectors to be used

  1. Disposal of the receipts. Are the whole of the receipts to be paid over to the charity or fund, or will any deductions be made for expenses, or other purpose? If yes, state specifically for what purpose and give an estimate of the sum which will be deducted.

  1. Is it proposed that remuneration should be paid out of the proceeds of the collection?
(a)to collectors?
(b)to other persons?
If so, at what rates and to what classes of person?
  1. Has the applicant, or, to the knowledge of the applicant, anyone associated with the promotion of the Collection, been refused a permit under the Act or had a permit revoked, if so give details.

Signature of person making this application:-…………………………………….………………………..

Name (in capitals)…………………………………………….………………….

Date…………………………………………………..

St Edmundsbury Borough Council 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 for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes.

For further information, see

This form should be returned not later than one month before the proposed collection date to:

Licensing Services

St Edmundsbury Borough Council
West Suffolk House
Western Way
Bury St Edmunds
Suffolk IP33 3YU

Phone: 01284 757400

Email:

Please ensure any return form for previous collections have been submitted.

Collections held in The Arc, Bury St Edmunds, also require the permission of the Centre Administrator - please contact 01284 706037