Form 2 Application for Eligibility Certificate by a Corporation (PDF ...

Form 2 Application for Eligibility Certificate by a Corporation (PDF ... Form 2 Application for Eligibility Certificate by a Corporation (PDF ...

from olgr.qld.gov.au More from this publisher

04.05.2014 Views

Form 2 August 2008 CONFIDENTIAL Racing Act 2002 (Section 207) Application For Eligibility Certificate By A Corporation ___________________________________________________________________________ (Name of Applicant Corporation) hereby makes application for an eligibility certificate under Section 207 of the Racing Act 2002. The application form has been completed in full and the applicable application fee is attached. Signature of Authorised Executive Officer: __________________ Date: ____ /____ /____ Office of Liquor, Gaming and Racing

Form 2

August 2008

CONFIDENTIAL

Racing Act 2002

(Section 207)

Application For Eligibility Certificate

By A Corporation

___________________________________________________________________________

(Name of Applicant Corporation)

hereby makes application for an eligibility certificate under Section 207 of the Racing Act

2002.

The application form has been completed in full and the applicable application fee is attached.

Signature of Authorised Executive Officer: __________________ Date: ____ /____ /____

Office of Liquor, Gaming and Racing

Version:

August 2008

COMPANY PROBITY FORM

This form is used to assist the completion of suitability checks performed on certain

companies that are or are associated with a Gaming Applicant/Licensee in Queensland

CONFIDENTIAL

Company to which this form relates:

This form has been submitted for the purpose of:

(e.g. “Application for Suppliers Licence under the Gaming Machine Act 1991”)

Name of Gaming Applicant/Licensee:

Note: This form should be completed in every particular. Incomplete forms may be returned

for completion. This may result in delays in the probity process and, if applicable, the

consideration of any licence application.

Queensland Office of Liquor, Gaming and Racing

Locked Bag 180

CITY EAST QLD 4002

AUSTRALIA

Telephone: (07) 3872 0852; Fax: (07) 3872 0951

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

IMPORTANT

WARNING

ABOUT FALSE OR MISLEADING INFORMATION

OR INCOMPLETE DISCLOSURE

Applicants and other persons completing this form should be aware

that action may be taken should information be supplied that is

false, misleading or incomplete in a material particular.

Persons who submit false or misleading information may be

prosecuted and fined.

Where a licence is issued and it is subsequently found that full

disclosures had not been made in relation to the licensee or its

associates or that false or misleading information had been

provided, show cause action may be taken. That action would

determine whether the licence should be cancelled or suspended.

INSTRUCTIONS TO BE READ

It is critical that the Instructions for Completion contained on pages

4 and 5 are read fully before this form is completed.

Signature: ___________________________________ 3

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

INSTRUCTIONS FOR COMPLETION

1. The Company Probity Form must be completed by:

• the Principal Executive Officer; or

• if the Principal Executive Officer does not have knowledge of the relevant facts,

another person who has the knowledge and is authorised by the company to

complete this form and which authority has been minuted.

2. Type or print in BLOCK LETTERS an answer to every question.

3. If an electronic version of this form is being completed, information supplied in

response to a question may be inserted but no question, or the order of questions, is to

be altered.

4. If a question does not apply to the company state “N/A” in response to that question.

5. If there is nothing to disclose in reply to a particular question state “Nil” in response to

that question.

6. If there is insufficient space on a printed form in which to answer a question, additional

information may be provided on an attachment page. When required to use an

attachment page precede each answer thereon with the title applicable to that question

and PRINT the company name on the page.

7. All dates should be completed in the form: Day / Month / Year.

8. Each page of this form and each attached page should be signed by the person

completing the form in the space provided.

9. This form is to be completed in the English language. Any documents required to be

provided are to have a certified English translation appended.

10. Documents or other information sought from authorities in Australia may not be

applicable to a company which has been incorporated in another country or which

originates from a company located overseas. In such cases the documents or equivalent

information should be obtained from the relevant authority of that country.

11. An asterisk (*) signifies “Delete whichever is not applicable”.

Signature: ___________________________________ 4

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

12. The completed form should be forwarded to:

The Executive Director

Office of Liquor, Gaming and Racing

Locked Bag 180

CITY EAST QLD 4002

AUSTRALIA

13. This form should be sealed in an envelope and marked:

“Private and Confidential

Attention: Executive Director, Office of Liquor, Gaming and Racing”.

14. Any further inquiries should be directed to the Probity Section, Office of Liquor,

Gaming and Racing, telephone (07) 3872 0852. (For calls outside Australia, the number

is 61 7 3872 0852.)

15. Note: A reference to a corporation includes a person.

16. Persons completing this form may require to be interviewed by officers of the

Office of Liquor, Gaming and Racing on one or more occasions. If you are required

to be interviewed the place and form of the interview will be at the discretion of the

Office of Liquor, Gaming and Racing. All persons to be interviewed are required to

bear their own cost of travel and accommodation, if applicable.

17. Persons completing this form should be aware that probity investigations will not be

commenced until required information is provided. In addition, a probity investigation

may be halted where additional information sought is not provided in a timely manner.

Acts administered by the Office of Liquor, Gaming and Racing also allow for

penalties to be imposed for the failure to supply information.

Signature: ___________________________________ 5

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

CERTIFICATE

I, ________________________________________________________________________________________

hereby declare as follows:

(a)

I hold the position of __________________________________________________________________

in _________________________________________________________________________________

(name of corporation)

and am duly authorised to complete this form (authority to complete should be minuted).

(b)

I certify that the particulars contained herein are true and correct in every detail and fully disclose the

information required to complete this form.

SIGNED at _____________________this___________________ day of _______________________20 ____

______________________________

(Signature)

In the presence of:

______________________________

(Signature of Witness)

Name of Witness:

Address of Witness:

_______________________________________________________________________

Telephone Number of Witness: ( ___ ) _____________________

ACKNOWLEDGEMENT AND UNDERTAKING

The company undertakes to supply the following information if requested to do so:

(a) copies of income tax returns and tax assessments;

(b) copies of minutes of shareholder and director meetings;

(d) copies of the company’s shareholder register.

The company notes and acknowledges that the information requested in this Company Probity Form may not

satisfy the probity requirements of the Office of Liquor, Gaming and Racing and that further information

may be requested.

Signature: ___________________________________ 6

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

AUTHORITY FOR RELEASE OF INFORMATION BY A CORPORATION

__________________________________________________________________________________

(name of corporation)

of ______________________________________________________________________________

(address)

hereinafter referred to as “the Corporation”:

1. acknowledges that the Casino Control Act 1982, the Gaming Machine Act 1991, the Keno Act

1996, the Lotteries Act 1997, the Interactive Gambling (Player Protection) Act 1998 Racing

Act 2002 and/or the Wagering Act 1998 (“the Acts”) authorises the Treasurer and/or Under

Treasurer of the State of Queensland (a State of Australia) to cause to be made investigations

about the Corporation for the purposes of determining the Corporation’s suitability for the

purposes of the Acts;

2. authorises the Treasurer, Under Treasurer and any person conducting any investigations or

enquires on behalf of the Treasurer or Under Treasurer for the purposes of the Acts, including

any officer of the Office of Liquor Gaming and Racing (“Authorised Person”), to obtain

any information and make any investigations or enquiries which relate to the Corporation and

may be relevant to any of the purposes of the Act, in any jurisdiction;

3. authorises an officer of the Australian Taxation Office, the manager or other principal officer of

any branch or office of a bank or financial institution in any jurisdiction to whom a copy of this

authority is presented to allow any Authorised Person to inspect and obtain copies of, or to

release to any Authorised Person, any record, document or other information of any kind in

written, electronic or any other form, which relates to the Corporation and is held by the

Australian Taxation Office, bank or financial institution; and

4. authorises any officer of any police service, law enforcement agency or regulatory body in any

jurisdiction to whom a copy of this authority is presented to release to any Authorised Person

any information or official record of any kind in written, electronic or any other form, which

relates to the Corporation and is held by the police service, agency or body, including any

information relating to the criminal history of the Corporation.

The Corporation undertakes that it will at all times sufficiently indemnify those officers referred to in

“3” and “4” above and the Authorised Person and keep those officers referred to in “3” and “4” above

and the Authorised Person indemnified against all liability in respect of the supply or disclosure in

accordance with the Acts, of the information, and against all actions, suits, proceedings, claims,

demands, costs and expenses whatsoever which may be taken against those officers referred to in “3”

and “4” above and the Authorised Person or incurred or become payable by those officers referred to

in “3” and “4” above or the Authorised Person in respect thereof.

SIGNED under the Common Seal this ________________ day of _____________________ 20 _____

Seal affixed by:

_____________________________

(Signature of authorised person)

_____________________________

(Name and position)

_____________________________

(Signature of authorised person)

_____________________________

(Name and position)

Signature: ___________________________________ 7

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

COMPANYETAILS – PART ONE

Information to be provided by way of attachments

The following attachments must accompany this form:

A. A brief history of the company (not required if a current licensee).

(This should include details of the original purpose and business of the company, the

names of the founders and what funds were initially injected and by whom.)

B. A “Statement of Company Records” to be prepared and signed by a Certified Practising

Accountant (CPA) or a qualified company auditor.

(This statement should –

(i)

(ii)

certify that the company’s records are up to date and, where applicable, in

agreement with Australian Securities and Investments Commission (ASIC)

records [or equivalent]. Company records include such records as share

registers, Company Constitution or equivalent, register of directors, secretaries

and managers, minutes of company meetings, financial reports, annual returns;

and

identify tax returns due and outstanding.)

C. A flow-chart supported by written text explaining the corporate structure in which the

company exists.

(Details should include the shareholding, the principal business and the names and

addresses of the directors of each company within the corporate structure.)

D. A list of companies in which any company identified in the corporate structure flowchart

holds greater or is able to exert influence over greater than 15% of the issued share

capital (if none, advise accordingly).

E. A description of the largest 20 shareholders of the company.

(Details should show the full name of each shareholder and the relevant number and

percentage of shares held.)

F. A copy of the current Company Constitution or equivalent.

G. Copies of the Certificate of Incorporation and each Certificate of Change of Name of

Company.

H. Copies of the financial statements for the company and any holding company, for the

last five (5) years. Copies of audited accounts should be provided, if applicable.

Signature: ___________________________________ 8

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

I. A copy of the Annual Reports of the company for the last five (5) years, if applicable.

If not applicable, provide reasons.

J. A copy of the company’s Chart of Accounts.

Signature: ___________________________________ 9

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

A. COMPANY DETAILS

PART TWO

Information to be provided by written answer

(i)

Full name of company as currently incorporated:

________________________________________________________________

(ii)

Other names the company has been known by:

________________________________________________________________

(iii)

Registered office: _________________________________________________

________________________________________________________________

(iv)

Address of principal place of business:

________________________________________________________________

Number of years at this address: ___________

(v)

Postal address: ___________________________________________________

________________________________________________________________

(vi)

Contact Details:

Telephones – Business: ( ____ ) __________________

After Hours: ( ____ ) __________________

Mobile:

_________________________

Email:

_____________________________________

(vii)

Preferred contact person: ___________________________________________

(viii) Date of incorporation: _____ / _____ / _____

Signature: ___________________________________ 10

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(ix)

(x)

Place of incorporation: _____________________________________________

Australian Company Number (ACN): _________________________________

(or equivalent – please specify).

(xi)

(xii)

Paid Up Capital: $ ________________

Name of the ultimate holding entity of the company:

________________________________________________________________

(xiii) List the following details for each current director, company secretary and any

other officeholder (including members of the management board, supervisory

board or any other body, by whatever name called) as well as the Chief

Executive Officer:

Name Position Residential Address

Place and

Date of Birth

(xiv) List the following details for each director and other officeholder who has

ceased to hold office during the last five (5) years:

Name

Last known residential address

Date of

Cessation

Signature: ___________________________________ 11

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(xv)

Apart from those identified in Questions (xiii) and (xiv) above and the 20 largest

shareholders (as advised by attachment – see Part One, item “E”), does any

person or organisation either directly or indirectly have a controlling interest or

significant influence in the company? (This may include but is not limited to a

finance provider.)

* YES / NO

If YES, please provide details:

________________________________________________________________

(xvi) Does the company have any other company or person acting on its behalf in

Australia or overseas?

* YES / NO

If YES, provide full details:

________________________________________________________________

(xvii) List all trading names and trademarks under which the company, its holding

company and subsidiaries of the holding company operate.

________________________________________________________________

Signature: ___________________________________ 12

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(xviii) Is the company a trustee of any trust?

* YES / NO

If YES, provide full details:

________________________________________________________________

(xix) Is the company or the ultimate holding entity of the company listed on the

Australian Stock Exchange (or overseas equivalent)?

* YES / NO

If YES, has the listed company every been fined, suspended or reprimanded for

breaches of the Australian Stock Exchange (or overseas equivalent) listing rules?

If YES, provide full details:

* YES / NO

________________________________________________________________

(xx)

List the following details for each company auditor and external accountant

engaged over the last five (5) years:

Firm/Company

Address

Period of

Engagement

Signature: ___________________________________ 13

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(xxi) To your knowledge while engaged by the company did such auditors or external

accountants become subject to investigation for any reason?

* YES / NO

If YES, provide full details:

________________________________________________________________

(xxii) List the following details of any legal advisers, solicitors and/or consultants

engaged over the last five (5) years:

Firm/Company

Address

Period and Capacity

of Engagement

(xxiii) Commencing with the current state and country and working backwards, list all

the states and countries in which the company has conducted business over the

last 20 years.

State and Country

Dates Business Conducted

From

To

Signature: ___________________________________ 14

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

B. ARRESTS, DETENTIONS AND LITIGATION

Please note that disclosure of these matters in respect to a conviction or charge under

a Queensland law for both the company and the individual is not limited by any time

frame.

(i)

Has the company, or any holding or subsidiary company, in Australia or

elsewhere:

(a) been convicted of an offence? * YES / NO

(b) been investigated by a law enforcement agency? * YES / NO

If YES, provide full details:

________________________________________________________________

(ii)

Has any office holder or employee of the company, acting in that capacity, in

Australia or elsewhere:

(a) been convicted of an offence? * YES / NO

(b) been investigated by a law enforcement agency? * YES / NO

(d)

(e)

been summoned before a court to answer any offence whatsoever?

* YES / NO

had any charge proven without the recording of a conviction? * YES / NO

(f) had civil proceedings instituted against them? * YES / NO

If YES, provide full details: _________________________________________

________________________________________________________________

Signature: ___________________________________ 15

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

The Criminal Law (Rehabilitation of Offenders) Act 1986 of Queensland

does not apply as Acts administered by OLGR are exempt. However, you may

be entitled to claim a right of non-disclosure of matters arising under federal

law or laws in other jurisdictions other than Queensland.

If you have any concerns in that regard you should contact either:

• the Privacy Commissioner (Federal) on the Privacy Hotline 1300 363 992;

or

• the equivalent body in your State; or

• your solicitor.

Note: “Law enforcement agency” includes but is not limited to State, Federal and Overseas

Agencies such as Police Services, Crime Authorities, Crime Commissions, Commissions against

Corruption, Securities and Investments Commissions, Customs Services, Taxation Offices,

Competition and Consumer Commissions and Gaming Authorities.

Note: If you are seeking entitlement to non-disclosure and will not be

answering the above questions please place a cross in the box. An attachment

setting out the reasons for non-disclosure including copies of the relevant

legislation should accompany this form.

(iii)

Has the company or any holding or subsidiary company been the subject of any

investigation by any government authority, i.e. by any State or Commonwealth

authority or department (or by any overseas equivalent)?

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

(iv)

Has the company or any holding or subsidiary company had civil proceedings

against it and is there any significant litigation currently in progress or pending?

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

Signature: ___________________________________ 16

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(v)

Has the company or any holding or subsidiary company ever had any licence,

certificate, authority or approval issued by a government agency in Australia or

elsewhere relating to the conduct of gaming or any other business terminated,

denied, suspended or revoked?

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

C. FINANCIAL

(i)

List the following details of any persons, companies or institutions from which

the company has current loans or has obtained funds on loan during the last

five (5) years.

(All amounts to be shown in Australian dollars)

Name of Lender

Amount

borrowed

(A$)

Purpose of

Loan

Date of

Commencement

Expected

Final

Repayment

Date

Secured/

Unsecured

(ii) Is there any relationship between the company and the lender? * YES / NO

If YES, provide full details: _________________________________________

________________________________________________________________

Signature: ___________________________________ 17

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(iii)

Has there been any material change to the financial situation of the company or

its holding company since the last accounts for the company were made up

which could impact upon the company’s operations?

* YES / NO

________________________________________________________________

(iv)

List the following details of all bank accounts operated by the company:

Account Name

Purpose of Loan

Bank, Branch and

Country

Account

Number

(v)

List the following details for each investment which currently represents greater

than 5% of the company’s total assets:

Description of Investment

Percentage of

Total Assets

Signature: ___________________________________ 18

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(vi)

Has the company or any holding or subsidiary company:

(a)

(b)

(c)

been placed into liquidation, receivership, scheme of arrangement or under

other formal insolvency administration;

had an agent for the mortgagee appointed; or

had an investigation into the affairs of the company authorised under the

Australian Securities and Investments Commission, its predecessors or

equivalent overseas body?

* YES / NO

If YES, complete the following:

Type of proceedings: _________________________________________

Commencement date: _____ / _____ / _____

Company name: _____________________________________________

Name of Trustee, Administrator, Liquidator or Receiver/Manager:

___________________________________________________________

Telephone: ( ___ ) _______________________

Details of circumstances leading to proceedings (including details of any

pending arrangements) and a copy of the external administrator’s report

should be attached if available:

___________________________________________________________

(vii)

Are there any outstanding claims or litigation which could adversely affect the

financial viability of the company?

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

(viii) If applying for a licence, advise whether the licence will be placed as collateral

against any indebtedness.

Signature: ___________________________________ 19

Office of Liquor, Gaming and Racing

MPANY PROBITY FORM

* YES / NO

If YES, please provide details:

________________________________________________________________

(ix)

Is the company and any holding or subsidiary company up to date with taxation

lodgements?

* YES / NO

If NO, please provide reasons: _______________________________________

________________________________________________________________

(x)

Is the company or any holding or subsidiary company, or a director of the

company or any holding or subsidiary company, being investigated by any

taxation authority in any country?

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

(xi)

Has the company or any holding or subsidiary company, or a director of the

company or any holding or subsidiary company, been investigated by any

taxation authority in any country?

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

Signature: ___________________________________ 20

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

D. INVOLVEMENT IN GAMING

(i)

Prior to this date has the company, any holding company or other related body

corporate, been associated with the ownership, administration or management

of:

(a) a casino;

(b) keno or lottery operations;

(d) race wagering or sports wagering operations (including bookmaking);

(e)

(f)

(g)

club, hotel or tavern;

the manufacture, assembling, selling, distributing, importing, supplying,

repairing or operation of gaming machines, in-line machines, lucky

envelope machines or other amusement devices;

a licensed monitoring operator.

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

Signature: ___________________________________ 21

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(ii)

Has the company, any holding company or other related body corporate had any

interest, financial or otherwise, in any other company or with any person or

business that is involved with the ownership, administration or management of:

(a) casino;

(b) keno or lottery operations;

(d) race wagering or sports wagering operations (including bookmaking);

(e)

(f)

(g)

club, hotel or tavern;

the manufacture, assembling, selling, distributing, importing, supplying,

repairing or operation of gaming machine, in-line machines, lucky

envelope machines or other amusement devices;

a licensed monitoring operator.

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

(iii)

Has the company, any holding company or other related body corporate been

subject to a probity investigation by any law enforcement authority or

government regulator?

* YES / NO

If YES, please provide details including name of investigating authority,

purpose of probity investigation and date of investigation:

________________________________________________________________

Signature: ___________________________________ 22

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

(iv)

Has the company, any holding company or other related body corporate ever

provided any financial assistance or other support to any other organisation or

person involved with the ownership, administration or management of:

(a) casino;

(b) keno or lottery operations;

(d) race wagering or sports wagering operations (including bookmaking);

(e)

(f)

(g)

club, hotel or tavern;

the manufacture, assembling, selling, distributing, importing, supplying,

repairing or operation of gaming machine, in-line machines, lucky

envelope machines or other amusement devices;

a licensed monitoring operator.

* YES / NO

If YES, please provide details: ______________________________________

________________________________________________________________

Signature: ___________________________________ 23

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

E. INFLUENCES, CONFLICT OF INTEREST AND DISQUALIFIED PERSONS

The Office of Liquor, Gaming and Racing must be advised of any matter which

could be seen as having a potential undue or improper influence on the conduct or

outcome of a probity investigation or an application for a licence. Disclosures must also

be made of persons with a potential conflict of interest or who may be classified as

disqualified persons.

(i) Are you aware of any person or shareholder associated with the company who is,

or who is the spouse or child of:

(a) a Member of the Legislative Assembly (Queensland); or

(b) a staff member of a Member of the Legislative Assembly (Queensland); or

* YES / NO

If YES, please supply details: ________________________________________

_________________________________________________________________

(ii) Has the company, a director, employee or shareholder of the company, or any

other person or organisation acting on behalf of the company, been involved in

any lobbying, meetings, discussions or negotiations with any government official

in regard to this probity investigation or, if applicable, this or any other

application for a gaming licence?

* YES / NO

If YES, please provide details of the official’s name, name of persons acting on

behalf of the company and the date and nature of any lobbying, meetings,

discussion or negotiations held:

_________________________________________________________________

Signature: ___________________________________ 24

Office of Liquor, Gaming and Racing

COMPANY PROBITY FORM

CHECKLIST

Before submitting this form please complete the following checklist. If you are unable to

complete the checklist you are advised that delays in processing the application or conducting

the probity investigation may be experienced. You should advise when the outstanding

matters are to be submitted.

I hereby certify I have:

read the Instructions for Completion;

signed each page of the form;

answered all questions in writing;

answered all questions completely;

completed and signed the Certificate of Acknowledgment and Undertaking

(page 6) and Authority for Release of Information (page 7).

and attached the following:

a brief history of the company;

a Statement of Company Records;

a corporate structure flow-chart with explanatory text;

a description of the largest 20 shareholders;

a copy of the company’s Constitution or equivalent;

a copy of the Certificate of Incorporation and any Certificate of Change of Name;

copies of the financial statements for the last five (5) years;

copies of the Annual Reports for the last five (5) years; and

a copy of the Chart of Accounts.

_________________________

(Signature)

_________________________

(Name)

(End)

Signature: ___________________________________ 25

Office of Liquor, Gaming and Racing

IMPORTANT

PRIVACY STATEMENT

The Office of Liquor, Gaming and Racing (OLGR)

is collecting the information on this form so that it can

meet its responsibilities as authorised in legislation

which governs the use of this form. OLGR may need to

give some or all of this information to other

organisations or individuals as provided for in the

legislation. OLGR may publish summary information

on our website (www.olgr.qld.gov.au).

OLGR is committed to protecting your privacy and will

comply with the Queensland Treasury Privacy Plan.

If you require any clarification of this Privacy Statement

and its application for this form, please contact OLGR

for further advice.

Form 2 Application for Eligibility Certificate by a Corporation (PDF ...

Form 2 Application for Eligibility Certificate by a Corporation (PDF ... ... View more Form 2 Application for Eligibility Certificate by a Corporation (PDF ...

Delete template?

Save as template ?

Form 2 Application for Eligibility Certificate by a Corporation (PDF ... Form 2 Application for Eligibility Certificate by a Corporation (PDF ...