A 12
[Subsidiary]
CAP. 148]
Gambling Regulations
[1977 Ed.
2. Type of society or club and objects
(sports, social)
3. Date society or club formed
4. President/Chairman Secretary Treasurer
(attach a copy of the Club Rules or Constitution)
Give details of the following persons involved in the administration of the society or club-
Accountant/Auditor
5.
6.
7.
Name Address
Has an officer of or any person involved in the administration of the club or society ever been convicted of an offence?
Yes/No
If “Yes”, give details. (Court where convicted, date of conviction, offence and penalty)
Give a list of the current assets under the control of the club or society and value thereof.
Asset Value
Give details of any other licences under the Gambling Ordinance for which application has previously been made
8.
Give details of any current licences under the Gambling Ordinance held by the club or society.
9.
Give details of any previous experience of applicant in respect of the licence applied for
I certify that the information supplied by me in this form is to the best of my knowledge and belief, both true and correct.
Dated this day of Position in club or society
(Signature) 19.......
J