APPLICATION FORM
FOR LEASE OF PREMISES AND EVENT INTHE BLACKHEADS HOUSE
1. The Lessee:
1.1 Name of the company/person: / 1.2 Registration Nr./Identification number:
1.3 Address: / 1.4 Telephone
1.5 Bank, SWIFT code: / 1.6 Account:
1.7 Name, surname and position taken by the signatory person:
1.8 Operating on the basis: / Articles of Association
Power of Attorney / Regulation
(other)______
2. Representative of the company/contact person:
Name, surname:
Mob. tel.:
E-mail:
3. Event:
3.1 Event date: / 3.2 Name of the event:
4. Premises
Please, mark the necessary premise and service: / Assembly Hall
Lubeck Hall
Latvian Hall
Historical rooms
Basement
Salon (auxiliary room)
All premises mentioned above / Cleaner (additional)
Technical staff (lights/sound) /if necessary from the Blackheads House(underline as appropriate)
Technical personnel (stagehand) /if necessary from the Blackheads House/
Premise arrangers, stage workers/if necessary from the Blackheads House/
Catering is planned during the event
Special effects will be used during the event - smoke equipment, open fire, confetti (underline as appropriate)
Technical equipment /if necessary from the Blackheads House/
Notes (catering, other technical needs)
Number of persons (expected visitors):
Estimated set-up time: / 00:00-00:00 / Time of the event: / 00:00-00:00
Rehearsal time: / 00:00-00:00 / Deconstruction time: / 00:00 -00:00

Booking conditions 1. In the case if the Lessee has unsettled liabilities towards SIA Rīgas nami on the day of submission of the present application, booking of the premises will be performed only after settlement of debt liabilities in full.

2. If the parties fails to conclude the agreement on the lease of premises within a time period of 6 weeks from receipt of the application form, SIA Rīgas nami shall reserve the right to cancel the booking without any warning.

3. This application form shall not give any rights to the Lessee to start to sell tickets - the Lessee shall be entitled to start selling of tickets only after entering into the agreement with SIA Rīgas nami.

4. The Lessee shall undertake to enter into the insurance contract regarding third party liability insurance of the Lessee, if the planned Event is to be recognized as a public event, in accordance with regulatory enactments of the Republic of Latvia.

5. The Lessee confirms by his or her signature that he or she has become acquainted with the booking conditions and agree with them.

5. Signature
Representative of the company (Name, Surname) / Signature / Date of completion