(Sections 4 and 6)
FORM A
(Chapter 21)
FORM OF APPLICATION FOR A LICENCE
(Section 4 (1)(b))
To:
*The State Secretary/Resident of ………………….. Division.
In pursuance of section 4(1) of the Public Collections Ordinance, 1996 [Cap.
21], I apply for a licence to promote and solicit a collection the particulars of which are given below:
1.
Name of applicant:
………..………………………….……………………….
(In block letters)
2.
NRIC No.: …………………………..…
Tel. No.:
………………………..
3.
Address: ……………………………………………………..………………..
(Where applicant is a charitable or voluntary organization)
Name of organization: ………………………………………..…………..…..
Registration No. ………………………..
Area of operation:
……....……...
Tel. No.: ………………………………………..
Registered address: ………………………………………..……………..…...
Name of official making the application: ……………………………..…..….
Designation: *President/Chairman/Secretary/Treasurer 4.
State purpose(s) of collection (including particulars of charitable purposes for which proceeds are to be applied):
………………………………………………………………………………………..
………………………………………………………………………………………..
………………………………………………………………………………………..
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………………………………………………………………………………………..
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5.
Period for which licence is required: ……………………….…………………
6.
(a)
Total cost of project:
…………………………………………………….
(b)
Amount of fund already available (to be supported by up-to-date Statement of Account): ……………………………………………….………..
(c)
Any collection/subscription being granted previously for this project.
If so, state licence number and date of issue:
………………………………………………………………………………….……
(d)
Amount of fund to be raised through public collections for which this licence is required: ………………………………………………………..……
7.
State how collections are to be made:
Method
Place
(Delete items which do not apply)
Name of
District: …………………………
(a)
Letter of appeal
(b)
Publicity (advertisement through newspaper)
Name of
Division: ………………………..
(c)
Door-to-door campaign
(d)
Donation from selected donors
State-wide: *YES/NO
(e)
Other means (please specify):
………….……………………......
…………….……………………..
……………….…………………..
8.
Is any other property besides money to
………………..…………………
be collected? If so, state nature of property and whether such property to be sold or given away?
…..………………………………
………..…………………………
………..…………………………
………..…………………………
9.
Approximately how many persons shall ………………………..…………
be authorized to act as collectors for the purposes of the collection?
…………………………..………
…………………………………..
…………………………………..
10. Will any remuneration be paid out of the
…………………………………..
proceeds of the collection to any collector or other person? If so, at what rate and to whom the remuneration are to be paid?
…………………………………..
…………………………………..
…………………………………..
…………………………………..
…………………………………..
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11.
Has the applicant, or to the knowledge …………………………………
…
of the applicant has anyone associated with the promotion of the collection, been refused a licence under the Ordinance, or had his licence been revoked? If so, give particulars of the refusal or revocation.
…………………………………
…
…………………………………
…
…………………………………
…
…………………………………
…
…………………………………
…
…………………………………
…
…………………………………
…
12.
Give names and particulars of persons authorized to act as collectors to solicit and collect public collections (attach a separate sheet, if necessary).
Name
NRIC No.
*Status in
Organization
Address
I, the undersigned, declare that all the information and particulars stated in this application are correct to the best of my knowledge and belief.
Signature of applicant: …………………………………
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Designation:
*President/Chairman/Secretary/Treasurer
Date: ……………………….
*Delete whichever is not applicable.
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FOR OFFICIAL USE
A.
File Reference:
B.
(1)
Comments by *Commissioner of Police/Divisional Superintendent of Police:
……………………………………………………………………………..
…
……………………………………………………………………..………
…
……………………………………………………………………..………
…
Date …………………………........
Signature: …………………………...
Place: …………………………..…
Designation: ………………………...
(2)
Comments by:
………………………………………..……………….
……………………………………………………………...………
…
………………………………………………………….………..…
…
Date ………………………………
Signature: …………………………...
Place: ……..………………………
Designation: ………………………...
C.
*Approved/Not approved.
Date: ……………………
……………………………..…………………
.
State Secretary/Resident of
……………………. Division
D.
Licence No.: …………………………………..
Date of issue: ………………………………….
Period of validity: From ……………………. to
16
…………………………...
Signature: …………………………………
(Registry)
Date: ………………………………………
*Delete whichever is not applicable.
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FORM B
(Chapter 21)
LICENCE TO PROMOTE AND SOLICIT A COLLECTION
(Section 4(3))
Licence No.: …………………………
………………………………………………………………of …….………………
…………………………………………………………………….…………………
……………. is licensed and authorized to promote and solicit public collection in the *Division/throughout the State for the purpose of: ……………….
……………………………………………………………………………………….
……………………………………………………………………………………….
subject to the TERMS AND CONDITIONS specified on next page.
Photograph of bearer of this licence:
NAME: ……………………………….
RM25.00 fee paid vide Treasury Receipt No.: ......................... dated ................
Dated this ……………………… day of ……………………
……………………………………………………………..
*State Secretary/Resident of ………………. Division c.c.:
*State Secretary
*All Residents
*Commissioner of Police
*Divisional Superintendent of Police
*Delete whichever is not applicable.
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TERMS AND CONDITIONS
(a)
This licence is valid from ……………….. to ……………….. both dates inclusive.
(b)
Collection to be of *money/property other than money/both money and other property.
(c)
Maximum number of collectors: ……………………...……………………
(d)
Maximum remuneration to be paid to—
(i)
collectors: ……………………………………………..…………...
(ii)
other persons: ………………………………………….…………..
(e)
Any person authorized by the promoter to act as a collector to solicit or collect public collection in any area shall carry and shall produce on demand an original copy of the certificate of authority and collector’s identification card issued to him.
(f)
All accounts to be furnished to the Licensing Officer under section 11 of the Public Collections Ordinance, 1996 [Cap. 21], shall be furnished on or before …………………………….
(g)
No proceeds from this collection shall be remitted to any person/organization outside Sarawak without prior written approval of the
State Secretary.
(Other conditions) ……………………………………..……………………………
…………………………………………………………..…………………………..
…………………………………………………………..…………………………..
…………………………………………………………..…………………………..
…………………………………………………………..…………………………..
…………………………………………………………..…………………………..
…………………………………………………………..…………………………..
(Note: Failure to comply with any of the terms and conditions stated herein constitutes an offence punishable with a fine of RM2,000.00 and imprisonment for 6 months, under section 13 of the Public Collections Ordinance, 1996 [Cap.
21]).
*Delete whichever is not applicable.
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FORM C
(Chapter 21)
COLLECTOR’S CERTIFICATE OF AUTHORITY
(Section 6(2))
Licence No. ……………………....
…………………………………………………. of
………………..………………..
(Name of collector in block letters)
(Address of collector)
……………………………………………………………………….……………….
is hereby authorized to solicit or collect public collection for ……..………………..
………………………………………………………………………….…………….
(Insert here the purpose of the collection)
in ……………………………………………………………...……………..……….
(Insert here the place or places within which the collector is authorized to collect)
from ……………………………………… to …………………………….………...
(Insert here the period during which the collector is authorized to collect)
………………………………..….
Name and signature of promoter
…..………..………….
Signature of collector
Date: ……………………………..
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FROM D
FORM OF COLLECTOR’S IDENTIFICATION CARD
(Section 6(2))
(Chapter 21)
COLLECTOR’S IDENTIFICATION CARD
(Section 6(2))
Licence No. …………………..
*Mr./Mrs/Miss …………………………………….………………………...
Name of collector
………………………………………..………………………………………………
Address
…………………………………………………………………...
NRIC No. or Passport No. of collector
……….……….
Age
……………………………………………………………………………..…………
Purpose of collection from ………………………………………… to ……….…………………………...
Validity period of this card both dates inclusive.
Photograph of collector
……………………………..……….
Name and signature of promoter
………………………….
Signature of collector
Date: ………………………..
*Delete whichever is not applicable.
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Chapter 21
PUBLIC COLLECTIONS ORDINANCE, 1996
LIST OF AMENDMENTS
Amending Law
Short Title
In force from-NIL-