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

Office of Liquor, Gaming and Racing
COMPANY PROBITY FORM
(iv)
Has the company, any holding company or other related body corporate ever
provided any financial assistance or other support to any other organisation or
person 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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Signature: ___________________________________ 23