Have you at any time been bankrupt or the benefit of a law for the Yes No relief of bankrupt or insolvent debtors or assigned your remuneration for the benefit of your creditors? If yes, provide details: Are you an undischarged bankrupt? Yes No Where do you Postcode: propose to operate as a bookmaker? Key Employees The names and addresses of all key employees employed by me are: Name Address Declaration under the Oaths, Affidavits and Declarations Act I (insert name): Of Postcode: (insert address): solemnly and sincerely declare that: The answers I have given to the questions in this application for a Bookmaker’s Licence or in any statement deemed to be part of this application, are true and correct; I have read and understood the information contained in this application and that the particulars supplied by me in this application are true and correct. I also declare that I am not financially or in any other way interested in illegal betting whatsoever, and I undertake that I will not engage in any such business while I am registered by the Northern Territory Racing Commission.; and I further state that: this declaration is true and correct; and I know that it is an offence to make a declaration that is false in any material particular. This declaration is on made at (date) Signature of applicant: Date: In the presence of
Have you at any time been bankrupt or the benefit of a law for the relief of bankrupt or insolvent debtors or assigned your remuneration for the benefit of your creditors? If yes, provide details: Yes No Are you an undischarged bankrupt? Yes No Where do you propose to operate as a bookmaker? Postcode: Key Employees The names and addresses of all key employees employed by me are: Name Address Declaration under the Oaths, Affidavits and Declarations Act I (insert name): Of (insert address): Postcode: solemnly and sincerely declare that: The answers I have given to the questions in this application for a Bookmaker’s Licence or in any statement deemed to be part of this application, are true and correct; I have read and understood the information contained in this application and that the particulars supplied by me in this application are true and correct. I also declare that I am not financially or in any other way interested in illegal betting whatsoever, and I undertake that I will not engage in any such business while I am registered by the Northern Territory Racing Commission.; and I further state that: this declaration is true and correct; and I know that it is an offence to make a declaration that is false in any material particular. This declaration is made at on (date) Signature of applicant: Date: In the presence of
racing-bookmaker-licence-application-form.docx