| 6. | Full name (surname in capital letters). |
| 7. | Former names (if different from names given in paragraph 6). |
| 8. | Aliases (if none used, state None). |
| 9. | Date and place of birth (attach a copy of birth certificate). |
| 10. | Nationality (if naturalised attach a copy of the naturalization certificate, and state here former nationality). |
| 11. | Full address at present time. |
| 12. | List addresses in full for previous 10 years where different from that given in paragraph 11, and give the related dates. |
| 13. | Marital status (if married, give the date and place of marriage, and full name of spouse, including the maiden name of wife). |
| 14. | Dependants (state full names, ages and addresses of all children). |
| 15. | Passport particulars (state the number, date and place of issue). |
| 16. | Give full details of your profession or occupation over the past 10 years (including the names and addresses of all employer(s) and the nature of your employment and give all of the relevant dates and state briefly the reasons for changes. |
| 17. | If your spouse is employed, give the name and address of the employer and the nature of the employment. |
| 18. | List all of the schools attended after elementary level, stating dates. |
| 19. | If you have ever held a privileged or professional licence e.g. accountant, legal, racing organisation, etc., give full details. |
| 20. | Have you ever been employed in, or had any connection at all with, a gaming enterprise in any country? (state YES or NO) ... |
| If YES, give full details of the employment or connection if different from those given in paragraph 16. |
| 21. | List the names, addresses and employment of your blood relatives i.e. mother, father, sisters and brothers. |
| 22. | Are you or your spouse a director of any companies, or a member of any partnerships? (state YES or NO) ... |
| If YES, list the companies, firms or partnerships, giving the name, address and the nature of the business of each. |
| 23. | In relation to the proposed gaming establishment, are you acting wholly or partly as a nominee or agent for, or trustee of, another person, persons, or organisations? (state YES or NO) ... |
| If YES, give the names and addresses of the person, persons, or organisation, and the precise nature of your relationship or arrangement between you. |
| 24. | Give the full details of your financial interest in the proposed gaming establishment. |
| 25. | Have you ever been convicted of an offence to include convictions in all countries, and to include all convictions relating to traffic offences? (state YES or NO) ... |
| If YES, give full details of the offence, the penalty, the Court at which convicted and the date. |
| 26. | Has your spouse ever been convicted of an offence in any country to exclude minor traffic violation? (state YES or NO) ... |
| If YES, give full details of the offence, the penalty, the Court at which convicted, and the date. |
| 27. | Have you or your spouse ever been declared bankrupt, or been the subject of a bankruptcy petition, or ever received a judgement against you in a civil court? (state YES or NO) ... |
| If YES, give full details. |
| 28. | Have you or your spouse ever been the plaintiff in a civil court? (state YES or NO) ... |
| If YES, give full details. |
| 29. | Has any company or firm of which you or your spouse were a partner, director or officer been the subject of a winding up petition? (state YES or NO) ... |
| If YES, give full details. |
| 30. | Give the names and addresses of all the banks at which you have, or have had an account during the past 10 years (the Board of the Gaming Authority reserves the right to seek references and other information from bank managers). |
| 31. | List the names of all relatives, both blood and by marriage, employed in the gaming industry; give relationship, position held, the name and address of employer. |