FORM 33: Application for Licence to own, possess, e.t.c, gambling machine or device

[]
1 Step 1
FORM 33: Application for Licence to own, possess, e.t.c, gambling machine or device
Name of applicant
2. Trading name of Applicant
3. Physical address of premises where the gaming machine(s) or device(s) will be kept:
0 /
4. Postal address of premises where the gaming machine(s) or device(s) will be kept:
0 /
5. Telephone
Fax
7. Tax Registration number:
8. Description of the gambling machine or device:
0 /
9. Purpose for which the gambling machine or device is being acquired:
0 /
10. Please provide details of the shareholders of the Applicant (if the Applicant is a company):
Name of Shareholders% of shares heldPostal Address
×
×
(2)
11. Please provide details of the directors of the Applicant (if the Applicant is a company):
Name Of DirectorPostal AddressTelephone No.
×
×
(2)
12. Please provide details of the Company Secretary (if the Applicant is a company):
Name of SecretariesResidential AddressTelephone No
×
×
(2)
13. Have any of the directors or the Company Secretary named above ever been convicted of an offence or been involved in any way with personal or company insolvency in Botswana or any other country: YES/NOpick one!
If yes, please give details of the nature of the offence, date and the sentence imposed:more details
0 /
14. Has the property of the Applicant ever been sequestrated: YES/NOpick one!
If yes, please give details below:more details
0 /

DOCUMENTS TO BE SUBMITTED WITH THIS APPLICATION

1. Certified copy of certificate of incorporation or certificate of registration (if the Applicant is a company);
Upload
2. Certified copies of share certificates (if the Applicant is a company);
Upload
3. Proof of directorship (certified copies)(if the Applicant is a company) ;
Upload
4.Tax clearance certificate or equivalent from country of origin;
Upload
5. Bank statements of the Applicant for the last three months;
Upload
6. Certified copies of share certificates;
Upload
7. Original set of fingerprints of the Applicant or directors of the Applicant;
Upload
8. Criminal clearance in respect of foreign applicants from law enforcement authorities in the respective countries of applicants;
Upload
9. Copies of tax returns and assessments of the individual for the previous five years.
Upload
I certify that the information supplied on this application form (please print name clearly) is true and correct. I understand that failure to provide true and correct information will result in the failure of this application.
Previous
Next