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

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:
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(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:
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(xvii) List all trading names and trademarks under which the company, its holding
company and subsidiaries of the holding company operate.
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Signature: ___________________________________ 12