Form 2 Application for Eligibility Certificate by a Corporation (PDF ...
Form 2 Application for Eligibility Certificate by a Corporation (PDF ... Form 2 Application for Eligibility Certificate by a Corporation (PDF ...
Office of Liquor, Gaming and Racing MPANY PROBITY FORM * YES / NO If YES, please provide details: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ (ix) Is the company and any holding or subsidiary company up to date with taxation lodgements? * YES / NO If NO, please provide reasons: _______________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ (x) Is the company or any holding or subsidiary company, or a director of the company or any holding or subsidiary company, being investigated by any taxation authority in any country? * YES / NO If YES, please provide details: ______________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ (xi) Has the company or any holding or subsidiary company, or a director of the company or any holding or subsidiary company, been investigated by any taxation authority in any country? * YES / NO If YES, please provide details: ______________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Signature: ___________________________________ 20
Office of Liquor, Gaming and Racing COMPANY PROBITY FORM D. INVOLVEMENT IN GAMING (i) Prior to this date has the company, any holding company or other related body corporate, been associated with the ownership, administration or management of: (a) a casino; (b) keno or lottery operations; (c) interactive gambling; (d) race wagering or sports wagering operations (including bookmaking); (e) (f) (g) club, hotel or tavern; the manufacture, assembling, selling, distributing, importing, supplying, repairing or operation of gaming machines, in-line machines, lucky envelope machines or other amusement devices; a licensed monitoring operator. * YES / NO If YES, please provide details: ______________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Signature: ___________________________________ 21
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Office of Liquor, Gaming and Racing<br />
MPANY PROBITY FORM<br />
* YES / NO<br />
If YES, please provide details:<br />
________________________________________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
(ix)<br />
Is the company and any holding or subsidiary company up to date with taxation<br />
lodgements?<br />
* YES / NO<br />
If NO, please provide reasons: _______________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
(x)<br />
Is the company or any holding or subsidiary company, or a director of the<br />
company or any holding or subsidiary company, being investigated <strong>by</strong> any<br />
taxation authority in any country?<br />
* YES / NO<br />
If YES, please provide details: ______________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
(xi)<br />
Has the company or any holding or subsidiary company, or a director of the<br />
company or any holding or subsidiary company, been investigated <strong>by</strong> any<br />
taxation authority in any country?<br />
* YES / NO<br />
If YES, please provide details: ______________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
Signature: ___________________________________ 20
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