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ORKNEY ISLANDS COUNCIL

CIVIC GOVERNMENT (SCOTLAND) ACT 1982

APPLICATION FOR PERMISSION TO HOLD A PUBLIC CHARITABLE COLLECTION

Please complete in block capitals

No.DetailsResponse
1.Name of Organisation
2.Address of Organisation

Tel. No.
3.If a registered charity give Charity Number
4.Full Name of Organiser
5.Address of Organiser

Tel. No.
Email.
6.Date of Birth of Organiser

Place of Birth of Organiser
7.Has Organisation previously uplifted a collection in the Orkney Islands Area?

If YES, state date of last collection
YES / NO
8.State purpose to which proceeds of collection will be applied

State what percentage of the proceeds of collection is to be applied to charitable purposes
9.Subject to the Rehabilitation of Offenders Act 1974 has Organisation or Organiser ever been convicted of an offence under Section 5 of the Police, Factories, etc. (Miscellaneous Provisions) Act 1916 or the House to House Collections Act 1939 or under regulations made under section 119(13) of the Civic Government (Scotland) Act 1982 or under Part III of the Charities Act 1992 or regulations made under section 73 of that Act or of any other offence which involved dishonesty or the commission of which would be likely to be facilitated by the grant of permission as applied for?YES / NO (if yes, give details)

Please turn over

IMAGE: Page 1 is a blank Orkney Islands Council application form for permission to hold a public charitable collection. It contains fields 1–9 covering the organisation, organiser, charity registration, previous collections, intended use of proceeds, and relevant convictions. The form is divided into numbered rows with response areas; no additional informational image content is present beyond the text transcribed above.

Page 2

No.DetailsResponse
10.Method of collection

(please tick as appropriate)
sealed box/can ☐     envelope ☐

other (please state)
...................................................
11.State method of appointing collectors
12.Type of collection requested

(please tick as appropriate)
House to House collection ☐

Street collection ☐

Both ☐
13.Areas of collection (e.g. Kirkwall, Stromness, Harray etc or the whole of the Islands Area)
14.Dates and times of collection

(restricted to one week per Organisation)

Please give two alternative dates if possible
1st Choice -

2nd Choice -

3rd Choice -
15.Signature of Organiser


Date of Application
.........................................................................

.........................................................................

FOR OFFICE USE ONLY

Application received on ......................................................

Police observations sought .................................................

Police observations obtained ........................................................

Permit issued ........................................................................

Accounts received .........................................................................

Please return this form to Committee Services, Orkney Islands Council, Council Offices, Kirkwall, Orkney KW15 1NY.

IMAGE: Page 2 continues the blank application form with fields 10–15 for the collection method, collector appointments, collection type, collection areas, dates and times, signature, and application date. It also contains an “FOR OFFICE USE ONLY” section and the return address for Committee Services, Orkney Islands Council. The form text is transcribed above; no additional informational image content is present.