FORM 48: Application for National Lottery License

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FORM 48: Application for National Lottery Licence
Name of applicant
2. Trading name of Applicant
3. Physical Address
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Postal Address
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Telephone
Fax
4. Please provide details of the shareholders of the Applicant (if the Applicant is a company):
Name of Shareholders% of shares heldPostal Address
×
×
(2)
5. Please provide details of the directors of the Applicant (if the Applicant is a company):
Name Of DirectorPostal AddressTelephone No.
×
×
(2)
6. Please provide details of the Company Secretary (if the Applicant is a company):
Name of SecretariesResidential AddressTelephone No
×
×
(2)
7. 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
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8. Has the Applicant, any subsidiary or associated entity of the Applicant ever been, or is currently being investigated by any law enforcement authority in Botswana or any other country: YES/NOpick one!
If yes, please give details below:more details
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9. Provide details of how the Applicant will be financing the operations of the National Lottery:
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10. Please provide details of the experience of the Applicant in conducting lotteries:
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11. Please provide the details of the envisaged employment levels of the National Lottery:
No. of citizen employeesNo. of non-citizen employees
×
×
(2)
12. Please provide the job classification of employees noted in (11) above:
Job ClassificationCitizensNon-Citizens
×
×
(2)
13. Please provide the names and contact details of four professional referees:
Name of ReferenceContact NoEmail
×
×
(2)

DOCUMENTS TO BE SUBMITTED WITH THIS APPLICATION

1. Certified copy of certificate of incorporation or certificate of registration (if the Applicant is a company);
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2. Certified copies of share certificates (if the Applicant is a company);
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3. Proof of directorship (certified copies)(if the Applicant is a company) ;
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4. Title deed, lease or sublease agreement of premises to be utilised for the operation of the National Lottery (certified copy);
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5. Detailed proposal of the project;
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6. Proof of funding for the project;
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7. Copies of audited financial statements;
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8. Certified copy of tax clearance certificate;
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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.
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