Category machine	Number currently authorised to provide	Number wish to provide (new or variation)	
C	……	……	
D	……	……	
Total	……	……	

NOTIFICATION OF 2 OR LESS GAMING MACHINES OR GAMING MACHINE
PERMIT APPLICATIONS (i.e. for greater than 2 machines) for: CONVERSION / NEW / VARIATION / TRANSFER

(FOR USE BY PREMISESLICENSEDTOSUPPLYALCOHOLFORCONSUMPTIONONTHEPREMISES)

Please refer to guidance notes at the back of this form before completing

To:  Kirklees Council Licensing Department Flint Street Depot
Flint Street
Fartown
Huddersfield, HD1 6LG

SECTION A – What do you want to do?

1. Please indicate what you would like to do

a)	Notify licensing authority that you intend to provide up to a maximum total of 2 gaming machines
category C and / or D (if you choose this option then please complete sections D and E)

b)	Apply to convert an existing Section 34 permit issued under the Gaming Act 1968, into a licensed premises gaming machine permit (i.e. for more than 2 gaming machines) (if you choose this option then please complete sections B, D and E)

c)	Apply for a new licensed premises gaming machine permit ((if you choose this option then please complete sections B, D and E)

d)	Apply to vary an existing licensed premises gaming machine permit (if you choose this option then please complete sections B, D and E)

e)	Apply to transfer an existing licensed premises gaming machine permit (if you choose this option then please complete sections C, D and E)	

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SECTION B – Application for grant (includes conversion, new and variation applications)

2.	How many gaming machines are you currently authorised to provide and if this is a new or variation application, how many do you wish to provide? (Please complete the boxes in the table)

3.	If you are currently authorised to provide more than 2 machines, please provide your existing Section 34 Gaming Act 1968 permit, or provide reasons stating why it cannot be provided.

Existing permit provided*
(reasons why existing permit cannot be provided) ………………………………………………

………………………………………………………………………………………………………….

………………………………………………………………………………………………………….	

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*Please keep a copy of your existing permit on the premises to which it relates.

NOTIFICATION OF 2 OR LESS GAMING MACHINES or
GAMING MACHINE PERMIT APPLICATIONS (i.e. for greater than 2 machines) for: CONVERSION / NEW / VARIATION / TRANSFER

(FOR USE BY PREMISES LICENSED TO SUPPLY ALCOHOL FOR CONSUMPTION ON THE PREMISES)

Section C – Application for permit transfer (i.e. where a transfer has been requested for the Licensing Act 2003 premises licence)

4.	Name of person requesting the transfer

……………………………………………………………………………………………………………………

5.	Confirmation that an application to transfer the relevant Licensing Act 2003 Premises Licence has  been:
Requested

Granted

6.	Please provide your existing permit, or provide reasons stating why it cannot be provided

Existing permit provided Reasons why existing permit cannot be provided
……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………	

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Section D – General Information	
7.    Name    of    Premises……………………………………………………………………………………………………………...	
8.    Address    of    Premises…………………………………………………………………………………………………………...	
…………………………………………………………………………………………………………………………..................	
9. Telephone number of Premises…………………………………………………………………………………..................	
10. Name of existing Premises Licence holder	
…………………………………………………………………………………………………………………………..................	
11. Address of Premises Licence holder (if different from 8 above)	
…………………………………………………………………………………………………………………………..................	
…………………………………………………………………………………………………………………………..................	
12. Telephone number (daytime) of Premises Licence holder	
…………………………………………………………………………………………………………………………..................	
13. E-mail address of Premises Licence holder (where available)	
…………………………………………………………………………………………………………………………..................	
14. Name, address, telephone and e-mail of agent (e.g. solicitor) if submitted on behalf of the applicant	
…………………………………………………………………………………………………………………………..................	
…………………………………………………………………………………………………………………………..................	
…………………………………………………………………………………………………………………………..................	
15. Licensing Act 2003 Premises Licence Reference (i.e. number)	
…………………………………………………………………………………………………………………………..................	

NOTIFICATION OF 2 OR LESS GAMING MACHINES or
GAMING MACHINE PERMIT APPLICATIONS (i.e. for greater than 2 machines) for: CONVERSION / NEW / VARIATION / TRANSFER

(FOR USE BY PREMISES LICENSED TO SUPPLY ALCOHOL FOR CONSUMPTION ON THE PREMISES)

Section E – Fee and Signature(s)
I enclose a sum of £	(cheques should be made payable to Kirklees Council)	□

I understand that I must comply with the Gaming Machine Code of Practice for Alcohol Licensed Premise Permits and Permissions issued by the Gambling Commission. (see guidance note 8)

Please note: It is an offence under section 342 of the Gambling Act 2005 if a person, without reasonable excuse, gives to a licensing authority for a purpose connected with that Act information which is false or misleading.

Personal Data
We have recently updated our Privacy Notice about how we use personal data provided to the Council. Further information can be found at:
http://www.kirklees.gov.uk/beta/information-and-data/pdf/privacy-notice-licensing-gambling-act.pdf

Dated ……………………………………………………………………………………………………………………………… Signed (by or on behalf of Licensing Act 2003 Premises Licence holder)….………………………………………... Print         Name………………………………………………………………………………………………………………………...

Official Use Only

Date of receipt: ……………………………………………………………… Signature and name of staff who received: …………………………… Date of receipt of fee: ………………………………………………
Signature and name of staff who received fee: ………………………………… Application accepted / returned (please delete as appropriate)
Date of premises licence (Licensing Act 2003) transfer (if applicable): …………………………

NOTIFICATION OF 2 OR LESS GAMING MACHINES or
GAMING MACHINE PERMIT APPLICATIONS (i.e. for greater than 2 machines) for: CONVERSION / NEW / VARIATION / TRANSFER

Guidance notes:
1.	This form is to be used for the notification of up to 2 gaming machines of categories C and / or D under

Section 282 of the Gambling Act 2005, or for the conversion of an existing Section 34 gaming machine permit under the Gaming Act 1968, or for a new application, variation or transfer of a alcohol licensed premises gaming machine permit under the Gambling Act 2005.
2.	The premises must be licensed under the Licensing Act 2003 to sell alcohol for consumption on the premises, without the requirement that alcohol is served only with food and there must be a bar for serving alcohol to customers on the premises.
3.	The gaming machines must be located on these licensed premises.

4.	A ‘Premises Licence holder’ is a person holding a Premises Licence under the Licensing Act 2003.

5.	There is no statutory limit to the number of machines which may be applied for although the licensing authority has some discretion in this regard. It should also be noted that the licensing authority can cancel the permit or vary the number of machines should the premises be mainly used for making gaming machines available for use on the premises (Schedule 13 paragraph 16 Gambling Act 2005). You may therefore wish to contact the licensing authority to ask whether there is a local policy as regards applications and whether application for certain numbers of machines are decided via a hearing of local councillors.
6.	The permit’s duration is indefinite as it is linked to the Licensing Act 2003 Premises Licence. There is a first annual fee payable within 30 days of grant and an annual fee payable after that before each anniversary of the date of issue of the permit. Failure to pay the annual fee may result in the cancellation of the permit. The annual fee is £50.00.  There are no annual fees payable for 2 machines or less.
7.	Sections 282 and 283, as well as SI 2007 / …….. of the Gambling Act 2005 provide for two types of gaming machines which can be located in alcohol licensed premises.  These are:
•	Category C: Maximum stake = £1 / Maximum prize = £100

•	Category D: Maximum stake = 10p or 30p non-monetary / Maximum prize = £5 cash or £8 non-monetary
8.	All alcohol licensed premises which provide gaming machines for  use  on  the  premises  must comply with any  relevant  Code  of  Practice  issued  by  the  Gambling  Commission  under  Section 24 of the Gambling Act 2005. The Gaming Machine Code of Practice for Alcohol licensed premises permits and permissions is available via the Gambling Commission’s website at: http://www.gamblingcommission.gov.uk/	Should you be unclear as to the provisions of the code of practice please contact the Gambling Commission or your local Council licensing service.
9.	This licensing authority must notify the applicant of its grant / refusal of the application for a permit as soon as is reasonable practicable after that decision to grant / refuse has been made.
10.	Where you are notifying the local licensing authority of 2 machines or less, you may wish to request an acknowledgement of receipt of the notification. The form attached to this application can be utilised for this purpose.

REQUEST FOR ACKNOWLDEGMENT OF RECEIPT OF MY NOTIFICATION OF 2 OR

LESS GAMING MACHINES

I, ………………………………………(insert name of the Licensing Act 2003 licence holder), request that this paper is returned to me at the following address and with the details below provided by the local licensing authority, so as to acknowledge my notification of 2 or less gaming machines at…………………………………………………………………………………..(insert name of premises).

Insert address to which you wish this acknowledgement to be sent:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

Official Use Only (to be completed by the local licensing authority)

Date of receipt of notification of 2 or less gaming machines: ……………………………………. Date of receipt of fee: …………………………………………………………………………………….. Signature: …………………………………………………………………………………………………… Local licensing authority stamp: