Amusement Licence Application

BETTING AND GAMING(NI) ORDER 2004 and BETTING, GAMING LOTTERIES & AMUSEMENTS (NORTHERN IRELAND) ORDER 1985

APPLICATION FOR THE GRANT/PROVISIONAL GRANT OF AN AMUSEMENT PERMIT

Premises for permit

Tel:

Email:

Permit type

Article 108(1)(c) up to £8 maximum prize value payout Access unrestricted

Article 108(1)(ca) up to £25 maximum cash prize payout Access 18 & over only

 
Cost £:
 

Please provide the Name(s) and Address(es) of any person by whom the business which is proposed to be carried on under the permit would be managed or for whose benefit the business would be carried on ; or

If the applicant is a body corporate, provide the names and addresses of the directors and any other persons having executive control of it and who have a financial interest in it.

"Individual"

Name

DOB

Address

Tel:

"Corporate"

Name

Tel

Directors Address DOB












Premises owner : name, address

Tel:

I certify that the premises are either :- ( select as appropriate )



If premises are of type (ii) then specify the number of gaming machines to be provided in conjunction with the other amusements.

Number of machines:

I being the occupier of the premises to be permitted, hereby make application for the grant / provisional grant of an Amusement Permit, pursuant to the provisions of Articles 111 and 115 of the above mentioned Order, for the authorisation of gaming by means of gaming machines, in accordance with the conditions of Article 108 of the above Order and subject to such conditions as the Council may impose.

I understand that I will serve a copy of this application on the PSNI and I give authority to the Council to inquire of them and any other relevant body as to my/our suitability in accordance with Article 109 of the said order.