(1) A qualified person may apply to the Revenue Commissioners for a licence authorising the person to carry on the business of, and act as, a remote bookmaker.

(2) An application under this section shall -

(a) be in such form and made in such manner as may be specified by the Revenue Commissioners,

(b) specify the name of the applicant and the address at which he ordinarily resides and the address of his principal office or place of business,

(c) in circumstances where the applicant proposes to carry on the business concerned under a trading name, specify that trading name,

(d) specify the applicant's e-mail address,

(e) specify a date (being either the first day of July next following the date of the making of the application or a day that is not more than 21 days after the date of the making of the application, whichever occurs sooner) from which he wishes the remote bookmaker's licence to have effect,

(f) in the case of an applicant who is an individual, be accompanied by the certificate of personal fitness issued to him in the period of 21 days preceding the application, and