To be completed by all Key Persons as described by the Act

APPLICATION INSTRUCTIONS

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM.

COMPLETING THIS FORM:

1. You must make accurate statements and include all material facts. Any misrepresentation, or the failure to provide requested information, may result in the denial of your
2. Read each question carefully prior to answering. Answer every question completely. Do not leave blank spaces. If a question does not apply to you, indicate “Does Not Apply” in response to that question. If there is nothing to disclose in response to a particular question, indicate “None” in response to that question. Failure to provide a response to every question could result in the rejection of your application.
3. All entries on this form, except initials and signatures, must be typed or printed in block lettering using blue ink. If your application is not legible, it will not be
4. If the space available is insufficient to respond to a question, you are to supply the required information on an attachment page and clearly identify which question you are
5. If you make any modification to the pre-printed questions or information contained in this form, your application will be Once your application is accepted, it becomes the property of the Gambling (Betting and Gaming) Control Commission (the Commission).

BEFORE YOU SUBMIT THIS FORM TO THE COMMISSION BE SURE THAT:

1. You have reviewed the filing instructions for the type of license, approval or qualification that you are seeking.
2. You have included all required attachments listed in this form.
3. The Statement of Truth form is notarized on the original application.
4. Every question has been answered completely.
5. You retain a completed copy of your application package for your own records.
6. You have completed all ancillary forms.
   
   INFORMATION VERIFICATION

1. The Gambling Control Commission (the Commission) must consider whether an applicant is suitable to be granted a license by verifying the background information provided and ensuring the existence of adequate financial resources to efficiently operate a gambling business in a manner consistent with the licensing objectives of the Gambling (Betting and Gaming) Control Act No. 8 of 2021 and the attendant legislation.
2. An application will not be considered until ALL questions have been satisfactorily answered and the application fee has been paid in full.
3. The Commission may request any additional information considered necessary to determine the suitability of the applicant for a license.

IMPORTANT

FAILURE TO ANSWER ANY QUESTION ON THIS FORM COMPLETELY AND TRUTHFULLY WILL RESULT IN DENIAL OF YOUR APPLICATION.

Pursuant to the Gambling (Gaming and Betting) Control Act No. 8 of 2021

Incorporators or founding persons, use Attachment 1 to provide the required information for each incorporator or founding person of the business entity.

List all other names under which the business entity has operated, along with appropriate time periods during which these names were being used. Use Attachment 2 to provide details.

Provide a description of the business done and intended to be done by the business entity and its parent, holding, subsidiary and intermediary companies or business entities and the general development of such business during the past five years (5), or such shorter period as the business entity or its parent, subsidiary and intermediary companies or business entities may have been engaged in business. The description shall include information on matters such as the following:

a. The principal products produced, and services rendered by the business entity and its parent, intermediary and subsidiary companies, the principal markets for said products or services and the methods of distribution.

b. The sources and availability of raw materials essential to the business of the entity.

Use Attachment 5 to provide information regarding key persons during the subsequent calendar year by each director, trustee, and key persons, of the business entity, whether such compensation is in the form of salary, wages, commissions, fees, securities or other ownership interest, bonuses or otherwise.

“Key Person”, in relation to a licensed business, means any person who – (a) is an owner, beneficial owner, director, controlling shareholder, associate, trustee, committee member or manager of a licensee; or (b) has the ability, directly or indirectly, to exert a significant influence over the management or operations of a licensee.

Use Attachment 6 to provide information with respect to each bank, savings and loan association or other financial institution, whether domestic or foreign, in which the business entity has or has had an account over the last 10 year period, regardless of whether such account was held in the name of the business entity, a nominee of the business entity or was otherwise under the direct or indirect control of the business entity.

The next question asks about any charges or offenses the business entity or any of its directors, trustees or officers may have committed or had filed against them. Prior to answering this question, carefully review the definitions and instructions that follow.

Definitions for purposes of this question:

a. “Charge” includes any indictment, complaint, information, summons, or other notice of the alleged commission of any “offense.”

b. “Offense” includes all felonies, crimes, high misdemeanors, disorderly persons offenses, and petty disorderly persons