PART I (PARTICULARS)

Individual
ADDRESS
Notification Address
Business
Business ADDRESS
Notification Address
Gaming machine
Tables
Slot machines
Attachments (Provide where Applicable)

DECLARATION

I declare that the information furnished by me in this application is true, correct and complete to the best of my knowledge. I understand that any incorrect, misleading or untrue information or the withholding of any relevant information may affect my registration for a Casino.