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Small Society Lottery Registration

Application for registration of Non-Commercial Society
Fields marked with * are required
A. Details of society applying for registration
1. Name of Society*
2. Please enter the society address postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
3. Postcode:
5. Address:
6. Society Address Line 1*
7. Society Address Line 2
8. Society Post town*
9. Society Postcode*
  Please use capital letters
10. Telephone number of Society*
11. Please state the purpose(s) for which the society is established and conducted*
12. If the society is a registered charity, please give the society’s unique charity registration number
13. Has the society held an operating licence under the Gambling Act 2005 in the period of five years ending with the date of this application?*
  
  Yes
  
  No
14. Has the operating licence been revoked in the period of five years ending with the date of this application?
  
  Yes
  
  No
15. Please state the reasons for revocation and enclose a copy of the notice of revocation if one is available
16. Please upload a copy of the notice of revocation
  Permitted file types: JPEG, PNG, PDF. Maximum file size: 2MB
18. Has the society applied for and been refused an operating licence in the period of five years ending with the date of this application?*
  
  Yes
  
  No