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

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