PUBLIC CHARITABLE COLLECTIONS
RETURN FOR A STREET OR HOUSE TO HOUSE COLLECTION		
Police, Factories, etc (Miscellaneous Provisions) Act 1916
Section 2 of House to House Collections Act 1939		
Please return completed form to: 
Licensing, Bromsgrove District Council, Parkside, Market Street, Bromsgrove, Worcestershire, B61 8DA	
FULL NAME OF PROMOTER (PERSON TO WHOM THE PERMIT WAS GRANTED) (BLOCK LETTERS)	
	
ADDRESS OF PROMOTER	
	
NAME OF CHARITY OR FUND WHICH IS TO BENEFIT	
	
DATE(S) OF COLLECTION	

 [PLEASE SHOW NIL ENTRIES]
PROCEEDS FROM COLLECTION	£.       p.	EXPENSES & APPLICATION OF PROCEEDS	£.       p.	
FROM COLLECTING BOXES 
(SEE SECOND PAGE)		PRINTING AND STATIONERY		
INTEREST ON PROCEEDS		POSTAGE		
OTHER ITEMS (Please Itemise)		ADVERTISING		
		COLLECTING BOXES		
		BADGES / EMBLEMS		
		OTHER ITEMS:		
CHARITY MARKET STALL:		PAYMENTS APPROVED UNDER REG. 15(2)		
CHARITY MARKET PITCH:		DISPOSAL OF BALANCE TO CHARITY (INSERT PARTICULARS)		
TOTAL		TOTAL		
[TOTALS SHOULD BE EQUAL TO SHOW WHERE ALL MONEY COLLECTED HAS BEEN DISPOSED]
CERTIFICATE OF THE PROMOTER
I certify that to the best of my knowledge and belief the above is a true account of the proceeds, expenses and application of the proceeds of the collection.
Signed:	Date:	

CERTIFICATE OF AUDITOR
I certify that I have obtained all the information and explanations required by me and that the above is in my opinion a true account of the proceeds, expenses and application of the proceeds of the collection.
Signed:	Date:	
Qualifications:	

DETAILS OF ADVERTISEMENT IN NEWSPAPER:	
NAME OF PAPER:		
DATE PUBLISHED		

PROCEEDS FROM COLLECTING BOXES
NAME OF COLLECTOR	COLLECTING BOX No	AMOUNT COLLECTED	

			

			

			

			

			
TOTAL
(This total to be entered on page 1)	£.                    p.