FORM 13: Application for a Bingo Licence

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FORM 13: Application for a Bingo Licence
Name of applicant
2. Trading name of Applicant
3. Physical Address
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4. Postal Address
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5. Telephone
Fax
6. Does the Applicant have an existing bingo licence:pick one!
If yes, please indicate the number of the existing bingo operations:
7. Please provide details of the shareholders of the Applicant (if the Applicant is a company):
Name of Shareholders% of shares heldPostal Address
×
×
(2)
8. Please provide details of the directors of the Applicant (if the Applicant is a company):
Name Of DirectorPostal AddressTelephone No.
×
×
(2)
9. Please provide details of the Company Secretary (if the Applicant is a company):
Name of SecretariesResidential AddressTelephone No
×
×
(2)
10. 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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11. 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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12. Please provide the names and addresses of the auditors of the Applicant:

Name of Auditor
Physical Address
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Postal Address
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Telephone
Fax
13. Provide details of all bank accounts, including foreign accounts, held by the Applicant at any time during the last five years:
BankAccount NumberBranch Name
×
×
(2)
14. Does the Applicant have any interest, financial or otherwise, in any other company, or has the Applicant ever provided any financial assistance or other support to any other company, person, association or other body, involved in the administration or management of a gambling-related business:pick one!
If yes, provide full details.more details
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16. Please provide the details of the envisaged employment levels of the proposed operation:

No. of citizen employees:
No. of non-citizen employees:
16. Please provide the job classification of employees noted in (16) above:
Job ClassificationCitizensNon-Citizens
×
×
(2)
17. Please provide the financial details of how the proposed business is going to be funded:more details
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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 gambling establishment (certified copy);
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5. Detailed proposal of the project with sketch plans for the proposed operation;
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6. Proof of funding for the gambling establishment;
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7. Copies of audited financial statements (if the Applicant is a company);
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8. Information of any application by the Applicant or any of the Applicant’s associates for a bingo licence anywhere in the world, and the outcome of such application;
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9. Certified copy of tax clearance certificate;
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10. 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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