FORM 9: Application for Renewal of Casino Licence

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FORM 9 Application for Renewal of Casino Licence

1. Name of applicant

2. Postal Address

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3. Physical Address

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4. Telephone

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5. Details of licence being renewed:

Licence No.:

Date of Issue:

Place of Issue:

Date of Expiry:

6. Please provide details of any changes to the operations of the business of the Applicant during the subsistence of the licence, i.e. change in employees, shareholders, directors, e.t.c.:more details

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DOCUMENTS TO BE SUBMITTED WITH THIS APPLICATION

1. Certified copies of share certificates (if the Applicant is a company);

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2. Proof of directorship (certified copy) (if the Applicant is a company);

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3. Title deed, lease or sublease agreement of premises to be utilised for the casino operation (certified copy);

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4. Copies of audited financial statements of the Applicant;

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5. Certified copy of tax clearance certificate(if the Applicant is a company);

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6. 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.