Lottery Permit Application Form

• Published date: 01 February 2019
• Issuer: Department of Justice

LP1

An Garda Síochána

Lottery Permit Application

Gaming and Lotteries Acts 1956 - 2019

NB: This form has been specified by the Minister for Justice under the provisions of section 27B

of the Gaming and Lotteries Act 1956 as inserted by section 11 of the Gaming and Lotteries

(Amendment) Act 2019

An applicatio n will not be considered until such time as of all the information as required and

requested by the Superintendent for the District where the premises to which t he application is

situated has been received.

Personal Identification Details

Surname:

First and Middle Name

Address of usual residence:

County: Eircode:

Contact telephone number

:

E mail address:

Date of Birth dd/mm/yyyy:

Gender:

Applicant’s local Garda Station:

Lottery Activity

Type and frequency of lottery activity proposed:

Date on which lottery activity is proposed to commence (dd/mm/yyyy):

(n.b. this date must be at least 60 days from date of application)

Lottery 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

cause:

Address of premises where lottery is to be promoted (if different to applicant’s

address: