Gambling Act 2005 - Temporary Use Notice
(for premises other than vessels)

Notice is hereby given under Part 9 of the Gambling Act 2005 that:
[Insert the name and address of the person or organisation giving the notice]

intends to use the following premises:
[Identify the premises giving an address and postcode]

for carrying on the following activities:
[Indicate the type of gaming which will take place under the notice]

during the following period:

Start date	End date	

Additional information

1.	Please describe the nature of the premises to which the notice relates:
[Where the activities to be authorised by the notice are to take place only in a part of the premises, include a description of the nature of the part of the premises in which the activities are taking

place and its location within the premises.]

2.	Please describe the nature of the event which is to take place (including the number of persons who are expected to participate in the event):

3.	Please give for each day of the period of the notice the times when activities are to begin and end.

Date	Start time (hh:mm)	Finish time (hh:mm)	

			

			

4.	Please give the operating licence number of the person or organisation giving the notice:

5(a) Please give the name of a person who is responsible for the conduct of the event to which the notice relates, and who will be available to be contacted during the course of the event:

Date	End date	Number of days	

			

			

5(c) Please give a telephone number at which that person can be contacted when the event is taking place:

6(a) Have any activities taken place, or will any activities take place, on the premises under any other temporary use notice during the period of 12 months ending on the last day of the period specified in this notice?
Yes	No

or will take place:

	

This notice is given on:
[Specify the date on which the notice is given.  This is the date on which it is sent or delivered to the licensing authority.]	

Declarations and Checklist (please tick or check)

I confirm that, to the best of my knowledge, the information contained in this notice is true. I understand that it is an offence under section 342 of the Gambling Act 2005 without reasonable excuse to give information which is false or misleading in, or in relation to, this notice.

Checklist:
The date on which this notice is given is more than 3 months before the date on which the activities to which this notice relates are due to start
Payment of the appropriate fee has been made/is enclosed
I understand  that premises cannot be  used under  temporary use  notices for more  than 21 days in any 12 month period.    I confirm that the notice will not lead to this limit being exceeded
I understand that each of the following persons and organisations must be given a copy	

of the notice and that they must receive it no later than 6 days after the date on which it is sent or delivered to the licensing authority:
o	The Gambling Commission,
o	The chief officer of police, or in Scotland the chief constable of the police, for any area in which the premises are wholly or partly situated, and
o		

Signature

Signature of the person giving the temporary use notice, or signature of the solicitor or other duly authorised agent acting on behalf of the person or organisation giving the notice. If you are signing on behalf of the person or organisation giving the notice, please state in what capacity:	
Signature:	
Print Name:

Date:	Capacity:

[Where the notice is given in an electronic form, the signature should be generated electronically

Contact Details

The following person can be contacted about this temporary use notice:

Tel:

The postal and/ or e-mail address for any correspondence associated with the notice is:	

ENDORSEMENT OF NOTICE BY LICENSING AUTHORITY

(For Licensing Authority use only)

Endorsed by:	

[Specify the name of the licensing authority by whom the notice is endorsed in accordance with section 227 of the Gambling Act 2005.]

Signed on behalf of the licensing authority: Signature:

Name: Date: Capacity: