City of London - Lottery Licencing Application Form

Full Organization Name

Mailing Address

E-mail Address

Website

Organization Telephone Number

The City Clerk's Office will review the documents submitted to determine eligibility for lottery licensing. Charitable registration with Revenue Canada or incorporation as a non-profit organization does NOT guarantee eligibility for lottery licensing.

Has your organization been in existence for at least 1 year?

Yes
No

Does your organization have a place of business in Ontario and can demonstrate that it is established to provide charitable services in Ontario and use proceeds for objects or purposes which benefit Ontario residents?

Yes
No

How many people comprise your bona fide membership?

Which of these four charitable classifications do the primary purposes of your organization relate to?

Relief of Poverty
The Advancement of Education
The Advancement of Religion
Other Charitable Purposes

If you selected Other Charitable Purposes, please select the applicable category or categories:

Is your organization currently licensed by any other municipality in Ontario?

Yes
No

If yes, which municipality?

If yes, which type of lottery?

Has the organization ever had a licence revoked, suspended or refused?

Yes
No

If yes, which municipality was the licence with?

Use of Proceeds

The organization's proposed use of proceeds from lottery licences must be for charitable programs and the programs must be consistent with the charitable purposes and objects of the organization.

Please indicate the specific purpose(s) or programs and associated costs you will be using lottery proceeds for and how they will benefit the residents of London.

Eligibility Documents

Please submit any of the documents listed below to support the eligibility of your organization. Items marked as strongly recommended are strongly recommended.

Strongly recommended documents:
• Incorporation Papers or Letters Patent
• Constitution and By-laws
• Notification of Charitable Registration (Canada Customs and Revenue Agency)
• Financial Statement for Previous Fiscal Year (audited, where applicable)

Additional supporting documents:
• The most recent Registered Charity Information Return & Public Information, as submitted to Canada Customs and Revenue Agency, if applicable
• Detailed outline of all programs/services in the previous year, and specific costs incurred in delivery
• Current operating budget
• Current listing of Board of Directors with contact information, and the expiry date of each person’s term in office
• Any other information which will assist in determining the charitable nature of the objects and purposes

Please upload all documents that support the eligibility of your organization.

Allowed file types: .jpg, .jpeg, .png and .pdf.

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