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

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
(c) been summoned before a court to answer any offence? * YES / NO
If YES, provide full details:
________________________________________________________________
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(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
(c) been charged 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: _________________________________________
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Signature: ___________________________________ 15