FORM 11: Application for Transfer of Casino Licence

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FORM 11 Application for Transfer of Casino Licence
1. I (Name of Applicant):
do hereby in terms of the provisions of the Act and these Regulations, make an application for the transfer of the casino licence issued to me, being licence no:
to

and confirm being aware of and understanding the provisions of the Act and these Regulations, insofar, as they pertain to this application.

2. Physical Address of the casino:
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3. Postal Address of the casino:
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4. Telephone
Fax
5. Please provide details of the shareholders of the transferee (if the transferee is a company):
Name of ShareholderNo. of SharesPostal AddressId or Passport No.:
×
×
(2)
6. Please provide details of the directors of the transferee (if the transferee is a company):
Name of DirectorNo. of SharesPostal AddressId or Passport No.:
×
×
(2)
7. Please provide a full description of the impact of the transfer of the licence on the business of the licensee, with specific reference to the following (separate sheet to be used): (a) Management structure; (b) Financial operations of the licensee; and (c) Operations of the licensee.
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DOCUMENTS TO BE SUBMITTED WITH THIS APPLICATION

1. Certified copies of share certificates of the transferee (if the transferee is a company);
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2. Proof of directorship (certified copies) of the transferee (if the transferee is a company);
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3. Title deed, lease or sublease agreement of premises to be utilised for the casino (certified copy);
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4. Certified copies of the agreements governing the transfer of the licence;
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5. Copies of audited financial statements of the transferee;
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6. Documentation or proof of any application by the Applicant or any of the Applicant’s associates for a casino licence anywhere in the world, and the outcome of such application;
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7. Certified copy of a tax clearance certificate of the transferee;
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8. Proof of shareholding.
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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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