House to House Collections Act 1939
House to House Collections Regulations 1947

Account of Expenses, Proceeds and Application of Proceeds of Collection of Money

Please complete the grey shaded areas
Name of the person to whom 
the permit was granted	     	
		
Address of the person to whom the permit was granted	     	
		
Purpose of collection	     
     	
		
Area to which account relates
	     	
		
Period to which account relates	     	

All amounts to be entered gross 
Proceeds of Collection	£	p	Expenses and Application of Proceeds	£	p	
From collecting boxes

	     	     	Printing & Stationary	     	     	
			Postage	     	     	
Bank Interest

	     	     	Advertising	     	     	
			Collecting Boxes	     	     	
Other items

     	     	     	Badges	     	     	
			Emblems	     	     	
	Other items

     	     	     	
	Disposal of Balance 
(insert particulars)

     	     	     	
TOTAL	     	     	TOTAL	     	     	

Certificate of the person to whom the permit was granted 
I certify that to the best of my knowledge and belief the above is a true account of the proceeds, expenses and application of the proceeds of the collection. 

Date:     						Signed:     
Print name:     

Certificate of independent responsible person 
I certify that the above is in my opinion a true account of the proceeds, expenses, and application of the proceeds of the collection. 

Date:     						Signed:     
Print name: