| 1. | A Personal Declaration Form must be completed by each person who is— |
| (a) | an applicant for a licence as an individual; |
| (b) | a director or officer in the company when the applicant is a company; |
| (c) | a person who is a shareholder in an applicant company; |
| (d) | a person who has a financial interest in an applicant company; |
| (e) | a person who will have actual and effective control over the licensed premises; |
| (f) | a person who will have actual and effective control over the gaming on premises approved by the Board of the Gaming Authority. |
| 2. | The completed Personal Declaration Forms must accompany the application for a licence (Form 1) when it is submitted to the Secretary of the Board of the Gaming Authority. (See paragraphs 11, 40, 41 and 43). |
| 3. | The discovery of any material falsification or omission of any information required in this Personal Declaration Form may affect the recommendations of the Board of the Gaming Authority with regard to the granting of the licence to which this form relates. |
| 4. | Any material change to the information or particulars given in this form must be notified to the Secretary of the Board of the Gaming Authority within 7 days. |
| 5. | The Person completing this form must accept the risk of any adverse public embarrassment, criticism or financial loss which may result from action taken by the Board of the Gaming Authority to verify the information contained in this form. |