Fill - Free fillable Club-gaming-or-club-machine-permit Club Gaming or Club Machine Permit PDF form

APPLICATION FORM FOR CLUB GAMING PERMIT OR CLUB MACHINE

PERMIT

(FOR USE

BY

APPLICANTS - MEMBERS' CLUBS, COMMERCIAL CLUBS AND MINERS'

WELFARE INSTITUTES)

If

you

are

completing

this

form

by

hand,

please

write

legibly

in

block

capitals

using

ink.

To:

Official

use

only

- licensing authority logo

or

symbol

[insert

name

and

address

of

relevant licensing

authority-

this

is

the authority in whose area

the premises relating

to

this application are

wholly

or

partly situated]

SECTION

A-Type

of

Application

1.

Please indicate type of application by ticking one of the boxes below:

D

Application

for

a

club

gaming

permit

D

Application

for

a

club

machine

permit

D

Application

to

renew

a

club

gaming

permit

D

Application

to

renew

a

club

machine

permit

SECTION B -

Existing

registration

under

Gaming

Act

1968

[To be completed

if

the applicant wishes

to

apply

as

an existing

Part

2

or

Part

3 operator.

Do

not

complete

if

applying

to

renew a permit]

Part

I

1.

Did the applicant have a Part 2 or Part 3 Registration under the Gaming Act 1968 that had

effect on

31

st August 2007? Yes D No D

Part

II

-

Complete

if

the

answer

to

question

1

is

'Yes':

2.

Please indicate the date on which the registration was due to expire (i.e. the date

it

was fixed to

expire when the registration was granted or last renewed)

3.

Is

the date given in answer to question 2 a date after

31

st August 2007? Yes D No D

4.

If the answer to question 3 is 'No', was the applicant's registration renewed on or after 1

st

September 2007? Yes D No D

Please give date of renewal

Part

Ill -

Complete

if

the

answer

to

question

1

is

'NO':

5.

Was the applicant first registered under Part 2 or Part 3 of the Gaming Act 1968

on

or after 1 st

September 2007? Yes

D No D

Please give date of first registration

Part

IV

6.

If the answer to either question 1 or 5 is 'Yes', please indicate which type of registration:

Part 2 Registration

D Part 3 Registration D

7.

Does this application relate to the same (or substantially the same) premises as those to which

the registration relates? Yes

D No D

8.

Is

this application made before the 'relevant date'? Yes D No D

[The 'relevant date'

is

the date on

which

the registration

is

due

to

expire,

except

where

the

applicant

is

registered

for

the first time

on

or

after

1

sf

September

2007,

or

the registration

is

renewed

on

or

after

that date. In those circumstances, the 'relevant date' is:

(a)

for

a

Part

2 registration, (in a

first

registration case) the

last

day

of

the

period

of

one

year

beginning on the date

of

registration,

or

(in a

renewal

case) the

last

day

of

the

period

of

ten

years

beginning on the date

of

renewal;

(b)

for

a

Part

3 registration, the

last

day

of

the

period

of

5

years

beginning

on

the date

of

registration

or

renewal.]

The

applicant

may

apply

as

an

existing

operator

if:

(a)

the

answer

to

questions

1,

3, 7

and

8 is

'Yes'

OR

(b)

the

answer

to

questions

1,

4,

7

and

8

is

'Yes'

OR

(c)

the

answer

to

questions

5, 7

and

8 is

'Yes'

AND

-

the

answer

to

question

6

is

'Part

2

Registration'

and

the

applicant

is

applying

for

a

club

gaming

permit;

OR

-

the

answer

to

question

6

is

'Part

3

Registration'

and

the

applicant

is

applying

for

a

club

machine

permit.

If

the

applicant

is

applying

as

an

existing

operator:

•

Do

NOT

complete

SECTION C

•

Relevant

documentation

must

be

provided

-

see

SECTION H

• A

different

application

fee is

payable

for

an

existing

operator.

SECTION C -

Fast-track

Procedure

[This section does

not

apply

to

Scotland]

9.

Please indicate if this application is made under the fast-track procedure [tick

as

appropriate]:

Yes D No D [to

apply

under

the fast-track procedure, the applicant

must

be

the

holder

of

a club

premises

certificate

under

section 72

of

the Licensing

Act

2003]

10. If the answer to question 9 is 'Yes', please complete the declaration below:

'I

hereby

certify

that

the applicant

for

a

permit

is

the

holder

of

a club

premises

certificate

under

section 72

of

the Licensing

Act

2003'

Full Name

Signature

Capacity

If

the

answer

to

question

9 is

'Yes'

relevant

documentation

must

be

provided

- see

SECTION H

SECTION D - Details

of

the

Applicant

11. Name

of

applicant

12. Address (including postcode) of premises

on

which the applicant operates

[any

gaming

or

gaming machines authorised

by

a relevant

permit

must

take place

or

be located on

these premises]

SECTION E -

Information

about

the

Applicant

If

the

applicant

is

a

miners'

welfare

institute,

complete

questions

13

to

16:

13.

Is

the applicant established and conducted for social and recreational purposes?

Yes

D No D

14. Are the applicant's affairs managed by a group of individuals of whom at least two thirds are

miners' representatives? Yes

D No D

15. Does the applicant operate on premises the use of which is regulated in accordance with a

charitable trust? Yes

D No D

16. If the answer to question 15 is 'Yes', has the charitable trust received money from any of the

following:

(a) the Miners' Welfare Fund established by section 20

of

the Mining Industry Act 1920,

(b) the former body corporate which was known

as

the Coal Industry Social Welfare Organisation

and incorporated under the Companies Act 1948, or

(c) the charitable trust known as the Coal Industry Social Welfare Organisation?

Yes

D No D

If

the

applicant

is

a

members'

club

or

commercial

club,

complete

questions

17

to

22

17.

Is

the applicant established with the purpose of functioning only for a

Ii

mited period of time?

Yes

D No D

18. Does the applicant have at least 25 individual members? Yes D No D

19.

Is

the applicant established and conducted for the benefit of its members? Yes D No D

20.

Is

the applicant established or conducted

as

a commercial enterprise? Yes D No D

21. Describe the purpose(s) for which the applicant is wholly or mainly established and conducted

22. If the applicant is established or conducted wholly or mainly for the purpose of the provision of

facilities for gaming, please specify the kinds

of

gaming

SECTION F - General

information

about

person

completing

this

application

form

on

behalf

of

applicant

23. Name

24. Capacity

25. Address (including postcode)

SECTION G -

Contact

details

for

correspondence

associated

with

this

application

26. Please tick one box as appropriate:

Address in section D

D Address in section F D Address below D:

Address (including postcode)

Telephone number

E-mail address (if the applicant is happy for correspondence

in

relation to this application to be

sent via e-mail)

SECTION H -

Declaration

27. Please complete the following declarations and checklist:

I [full

name]

a.

make this application

on

behalf of the applicant and have authority to act on behalf

of

the

applicant.

b.

confirm that I am aware of any relevant provision

of

a code

of

practice issued

by

the Gambling

Commission under section 24 of the Gambling Act 2005 about the location and operation

of

a

gaming machine.

c.

confirm that I am aware that the permit to which this application relates will be subject to the

relevant conditions specified

in

section

271

or 273 of the Gambling Act 2005.

d.

confirm that I am aware that (unless this application is made under the fast-track procedure) the

applicant must send a copy of this application and any accompanying documents to the Gambling

Commission and the chief officer of police (or chief constable

in

Scotland) within a period

of

seven

days beginning

on

the date this application is made.

e.

confirm

that,

to

the

best

of

my

knowledge,

the

information

contained

in

this

application

is

true.

I

understand

that

it

is

an

offence

under

section

342

of

the

Gambling

Act

2005

to

give

information

which

is

false

or

misleading

in,

or

in

relation

to,

this

application.

Checklist [tick

as

appropriate]:

D Payment

of

the appropriate fee

of£

is enclosed.

D A copy of the existing club gaming permit

or

club machine permit is enclosed [only applies

to

applications

to

renew a permit]

D A copy of the registration certificate issued under Part 2

of

the Gaming Act 1968 is enclosed

[only applies

if

the applicant wishes

to

apply

as

an existing

Part

2 operator]

D A copy of the registration certificate issued under Part 3

of

the Gaming Act 1968 is enclosed

[only applies

if

the applicant wishes

to

apply

as

an existing

Part

3 operator]

D The applicant's club premises certificate issued under section 72

of

the Licensing Act 2003 is

enclosed [only applies

if

the applicant has completed the declaration in section

CJ

Signature

Date

Capacity

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