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

Office of Liquor, Gaming and Racing
COMPANY PROBITY FORM
(ii)
Has the company, any holding company or other related body corporate had any
interest, financial or otherwise, in any other company or with any person or
business that is involved with the ownership, administration or management of:
(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 machine, in-line machines, lucky
envelope machines or other amusement devices;
a licensed monitoring operator.
* YES / NO
If YES, please provide details: ______________________________________
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(iii)
Has the company, any holding company or other related body corporate been
subject to a probity investigation by any law enforcement authority or
government regulator?
* YES / NO
If YES, please provide details including name of investigating authority,
purpose of probity investigation and date of investigation:
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Signature: ___________________________________ 22