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Application for a provisional statement

Use this form to apply for a provisional statement under the Gambling Act 2005.

This form consists of 5 pages and will take approximately 20 minutes to complete. Fields marked with a * are mandatory and require completion.

The fee for this form is between £1000.00 and £1500.00 (depending on premises type) and is payable upon completion of this form.


Before you start

Please ensure you have:

  • a plan of the premises
  • operating licence (if applicable)
  • a valid email address to receive confirmation of payment
  • your debit or credit card details, as after completing this form you will be taken to the payment portal.

    Please note: If your premises is a vessel or an authorisation to be converted under the Betting, Gaming and Lotteries Act 1963 or the Gaming Act 1968, then an application should be made on the relevant form for that type of premises or application.

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