• Roll Listing Application - Prior To Starting Application

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    In this application, when we use the word ‘you’ we are referring to the entity applying for listing on the Roll of Recognized Manufacturers, Suppliers and Testers of Gaming Equipment.

    The following online application form can be saved and returned to at a later time if required.

    Applicants must ensure their application is completed, as incomplete applications (including attachments) will not be accepted by the Tasmanian Liquor and Gaming Commission.

    Please note it is an offence to provide false and misleading information at any stage during this process.

    Electronic documents or photos lodged must be in .pdf, .doc, .docx, .xls, .xlsx, .zip, .mpg, .jpg, .jpeg, .png or .gif file formats.

  • Applicant Type

  • Please tick one or more of the following options relating to activities you are undertaking:

  • Applicant Details

  • Entity Type

  • {entityType} Applicant Details

  • Date of birth*
     / /
  • Linked to a trust for the purposes of this application?*
  • Registered Address Type
  • Format: (00) 0000 0000.
  • Format: 0000 000 000.

  • Attachments

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  • Business Affiliations

  • Do you have any other company, or person, acting on your behalf in Australia or overseas?*
  • Do you have any other agency or branch in Australia or overseas?*
  • Have you, as the entity applying for this authority, ever changed your trading or company name?*
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  • Do you have, or do you use, or have you previously used, any other business name?*
  • Do you have a relationship with any entity who is licensed to manufacture gaming equipment in Australia?*
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  • Litigation History

  • Have you ever been convicted of, or pleaded guilty to, an offence?*
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  • Are you aware of any current charges or summons against you, which are before a Court for any offence or violation?*
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  • Have you had any action taken against you for not complying with a law of any jurisdiction in Australia relating to industrial relations or workplace safety?*
  • Has a director ever been disqualified from acting as such under any provision of current or previous Australian Corporations and Securities Legislation (or overseas equivalent)?*
  • Have you ever been investigated by the Australian Securities and Investments Commission or any other Government authority to your knowledge (eg RIA, APRA, ACCC)?*
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  • Do you have any amounts owing to the Australian Taxation Office?*
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  • Have you ever had any action taken against you or are you currently being investigated by the Australian Taxation Office?*
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  • Have you ever been associated with a company that is currently, or has been, investigated by the Australian Securities and Investments Commission or any other Government authority to your knowledge?*
  • Are you the subject of any civil litigation?*
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  • Gaming History

  • Do you hold a current authority in the casino/gaming industry, either in Australia or overseas?*
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  • Have you applied for an authority in the casino/gaming industry either in Australia or overseas?*
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  • Have you ever been refused an authority in the casino/gaming industry in Australia or overseas, or had such an authority revoked?*
  • Have you ever been the subject of disciplinary action in the context of operating in the casino/gaming industry?*

  • Proof of Identification

  • To establish the identity of a person, evidence of identity is required. The list of accepted identity documents is available at Proof of identity | Treasury and Finance Tasmania

    Electronic documents or photos lodged must be in .pdf, .doc, .docx, .zip, .mpg, .jpg, .jpeg, .png or .gif file formats.

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  • Have you ever been bankrupt, or are currently an undischarged bankrupt?*
  • Have you ever entered into a debt agreement?*

  • Financial History

  • Have you ever been bankrupt or are currently an undischarged bankrupt? If yes, please provide details.*
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  • Have you ever been placed in external administration (that is liquidation, receivership, administration or scheme of arrangement)*
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  • Have you acted as guarantor for any person or entity which is currently in default of that financial agreement?*
  • Do you have any financial interest whether directly or indirectly, with an individual or in any business, whether registered or not, in Australia or elsewhere?*
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  • Associate Details

  • Associates are persons who have a relevant financial interest, position and significant influence in the business and/or are a spouse or relative. The applicant MUST attach a completed Associate Details Form for each associate to this application.

    • Associate 1 
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    • Associate 2 
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    • Associate 6 
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    • Associate 7 
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    • Associate 8 
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    • Associate 9 
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    • Associate 10 
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    • Associate 18 
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    • Associate 20 
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    • End of repeating associate section 

  • Nominated Associate Details

  • Format: (00) 0000 0000.
  • Format: 0000 000 000.

  • Payment

  • Your application fee is $955.

    You will need to pay this application fee before you submit your form. Please make an Electronic Funds Transfer for the total application fee amount to the following bank account:

    BSB: 037-001

    Acc No. 268825

    Acc Name: Revenue EFT

    Reference/Description: RL "Your applicant name"

    Please note: Applicant name that you include in the EFT reference/description may not contain hyphens, apostrophes or special characters. Please limit Reference to 18 characters.

    Please include the Receipt number generated for your EFT transaction below.

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  • Consent & Declaration

  • Personal Information Protection Statement

    Personal information is collected by the Department of Treasury and Finance, the Commissioner for Licensing, and the Tasmanian Liquor and Gaming Commission. The Liquor and Gaming Branch of Treasury can be contacted at Liquor and Gaming Branch, GPO Box 1374, HOBART TAS 7001; by telephone at (03) 6166 4040; or by email at gaming@treasury.tas.gov.au

    You have a right under the Personal Information Protection Act 2004 to access personal information held about you. Further information about Treasury s Personal Information Protection Policy, including how to make a request to access details of your personal information, is available at www.treasury.tas.gov.au/about-us/corporate-governance/personal-information-protection-policy

    Personal information is collected for the purposes of managing, assessing, advising on, and determining the relevant application, as well as for ongoing regulation under the Gaming Control Act 1993 (Tasmania) and relevant regulations.

    Personal information may be disclosed to contractors and agents of Treasury, as well as to courts, law enforcement agencies, finance agencies, identity verification services, and other organisations authorised to collect it.

    Failure to provide required information may mean that your application cannot be processed.

    Declaration

    I acknowledge that it is an offence under the Gaming Control Act 1993 to give false or misleading information in relation to an application for a gaming licence or permit. I also acknowledge that giving a false or misleading statement, or failing to disclose relevant information is a ground for disciplinary action. I certify that the particulars contained in the completed application form are true and correct in every detail and fully disclose the information required to complete this application.

    By submitting this application and providing my email address, I consent to information being given by means of electronic communication as defined by the Electronic Transactions Act 2000 (Tasmania)

    Consent

    I authorise and consent to:

    • My information being checked with the document issuer or official record holder via third party systems for the purpose of confirming my identity.

    • A copy of this consent and my personal information being provided to Tasmania Police or any Australian law enforcement agency for the purpose of conducting a Nationally Coordinated Criminal History Check. I also consent to the release of any criminal history records recorded against my name in any Australian jurisdiction to the Department of Treasury and Finance, the Commissioner for Licensing and/or the Tasmanian Liquor and Gaming Commission for any regulatory function or purpose under the Liquor Licensing Act 1990 or the Gaming Control Act 1993.

    • The Tasmanian Liquor and Gaming Commission, Commissioner for Licensing and any member of the Department of Treasury and Finance to obtain consumer credit information from Experian Data Registries Pty Ltd. In this context where us or we means the Liquor and Gaming Branch (Access Seeker) and you or your means the applicant or associate:

    • By nominating us as an Access Seeker, we will be using your access rights to consumer credit information which means that you may be charged in the future for information that would have been available for free from credit reporting bodies.

    • We collect information from Experian, a credit reporting body. Further information on how Experian collects, holds, uses and discloses your credit information is available from www.experian.com.au.

    • To make a change to credit information, you need to say how it is wrong and provide documentation to support your view. You agree to provide the credit reporting body (through us) certified copies of documents or statutory declarations where no other documentation is available (Supporting Documentation). Where we represent you in any required correction of information, you agree that we will provide the Supporting Documentation to the credit reporting body, and we will be responsible for providing the credit reporting body s response to your correction request to you both truthfully and accurately.

  • By submitting this application and providing my email address, I consent to information being given by means of electronic communication as defined by the Electronic Transactions Act 2000 (Tasmania).

    I, {nameOf} the applicant, agree to the above declaration.

  • By submitting this application and providing my email address, I consent to information being given by means of electronic communication as defined by the Electronic Transactions Act 2000 (Tasmania).

    I, {contactPerson}, agree to the above declaration in full, on behalf of {companyName109}.

  • Clear

  • If all details are correct, please click submit.

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