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

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

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