Application for a certificate of personal fitness




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BETTING ACT 1931
APPLICATION FOR A CERTIFICATE OF PERSONAL FITNESS

(From a person who is ordinarily resident in the State and who is seeking a bookmaker’s licence)


NB An application will not be considered until such time as all the required information as detailed in the Notes section of this form has been received.
To: Superintendent, An Garda Síochána,

I,........................................................................................................................................

of: (full address including postcode) ....................................................................................................................................... and representing (full company name and registered address including postcode)

..........................................................................................................................................

having inserted an advertisement in.................................................................................

dated the ......................................... day of ......................................................., 20.......

of my intention to make this application, copy of which is attached, hereby apply to you for a certificate that I am a proper person to have a bookmaker's licence. My application for a bookmaker's licence is in respect of a racecourse licence and or registered premises.
Position held in company (where applicable):
Telephone number: .....................................

Mobile phone number: ...................................

E-mail address: ............................

Date of birth: .....................................


Dated this .......................... day of ..........................................................., 20....

Signed ..................................................................................................................

Name (BLOCK CAPITALS)…………………………………..


NOTES
This form must be accompanied by the following:



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