Gaming Permit Application Form (PDF version)

An Garda Síochána
Gaming Permit Application
Gaming and Lotteries Acts 1956 - 2019
NB: This form has been specified by the Minister for Justice under the prov isions of section 9A of
the Gaming and Lotteries Act 1956 as inserted by section 4 of the Gaming and Lotteries
(Amendment) Act 2019.
An application will not be considered until such time as all the information required and requested
by the Superintendent for the District where the premises to which the application is situated has
been received.
Personal Identification Details
First and Middle Name
Address of usual residence:
County: Eircode:
Contact telephone number
E mail address:
Date of Birth: (dd/mm/yyyy):
Applicant’s local Garda Station:
Gaming Activity
Type and frequency of gaming activity proposed:
Date on which gaming activity is proposed to commence (dd/mm/yyyy):
(n.b. this date must be at least 60 days from date of application)
Gaming promoted on behalf of (please indicate one only):
Sports Club/Community Organisation:
Charitable/Philanthropic cause:
Promoter’s own benefit:
Name of Sports Club/Community Organisation or Charitable/Philanthropic

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