Form 1

Betting Act 1931

Application for Bookmaker's Licence under section 7(1) of the Betting Act 1931

(This form when completed should be forwarded to the applicant's local Revenue office.)

I 1........................................................of 2...........................................................................

1 Insert full name.

2 Insert full address.

being the person named in the attached certificate of personal fitness granted by the 3 Minister for Justice, Equality and Law Reform/Superintendent of the Garda Siochana for the 4..............................District hereby apply to the Revenue Commissioners for licence to act as a bookmaker from the 5 20 to the 30 November 20 inclusive.

3 Delete inapplicable words.

4 Insert District.

5 Insert either the next following 1 December or a date not more than 14 days after the date of the application.

Signature...................................

Date 6.........................................

6 The application must be made within 21 days after the issue of the certificate of personal fitness and must be accompanied by-1) an unmounted photograph of the applicant's full face and shoulders with head uncovered. The photograph must have been taken not more than 12 months prior to the date of the application and must be approximately 8 centimetres long and 5.5 centimetres wide, and 2) a remittance for the proper amount of the excise duty payable in respect of the licence for which the application is being made.

Form 2

Betting Act 1931

Bookmaker's Licence

The Revenue Commissioners hereby licence*..........................................................

residing at

in the County of