| (To be completed by all applicants) |
| 44. | Any further information which the Applicant would wish to be taken into account when considering this Application should be given below. |
| 45. | The following declaration must be signed by the Applicant himself or herself if he or she is an individual, or by a Director and the Secretary of the Company, if the Applicant is a Company. |
| I/We certify to the best of my/our knowledge and belief that the information given in this Application is complete and correct. Further I/We undertake to inform the Board of the Gaming Authority within 7 days whenever any of the information given in this Application ceases to be valid either wholly or in part, and/or whenever any of the particulars given in this Application are altered in any form whatsoever. |
| DATE ....................................... | SIGNED ............................................. |
| TITLE ................................................ |
| SIGNED ............................................. |
| TITLE ................................................ |