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

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

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