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Forms

Click on the links below to open, print out or download .pdf* versions of the following gambling licence application and information forms.

Class 3 Gambling Only
Class 4 Gambling Only
Audited Financial Statements (for Class 4 Gambling)
Standard Forms
Casino Gambling Only

If you require hard copies of any of these forms please contact the Gaming Compliance Unit.

View our Register of All Forms Related to Class 3 & 4 Gambling .pdf (9k)*

Note: Forms GC1-GC14 (excluding GC9) were updated in July 2009 - please use the new versions from now on.

Class 3 Gambling Only

Class 3 Operator's (New) Licence .pdf (315k)* GC11
Application for a new licence to conduct Class 3 gambling.

Class 3 Operator's (Amend) Licence .pdf (227k)* GC12
Application to amend a licence to conduct Class 3 gambling.

Class 3 Housie Operator's (Renew) Licence .pdf (242k)* GC14
Application to renew a licence to conduct Class 3 gambling - Housie only.

Class 3 & 4 Personal Information Form .pdf (284k)* GC5
Personal information form for operators of Class 3 and Class 4 gambling.

Class 3 Audit and Prize Statement (Excluding Housie) .pdf (282k)* GC13
Audit and Prize Statement to be completed after a Class 3 gambling activity has been drawn/determined.

Calcutta Calculation Sheet .pdf (29k)*
This form replaces the 'Calcutta Auction Record Sheet'. It covers the Calcutta operation in its entirety rather than just the auction, which is only one aspect of this gambling activity. This sheet is to be attached to the Class 3 Audit and Prize Statement. Updated September 2009.

Licensed Promoter's Forms GC8 / GC10 / GC9
Licensed Promoter's Licence Application, Licensed Promoter's Key Person Information, and Licensed Promoter and Society Agreement.

If you require hard copies of any of these forms please contact the Gaming Compliance Unit.

Class 4 Gambling Only

New Class 4 Operator's Licence .pdf (310k)* GC1
Use this form if you are a club or other corporate society wanting to operate gaming machines at a club or public venue and you do not currently hold Class 4 gambling licences.

You must also complete a

New Class 4 Venue Licence

.pdf (306k)

GC3

application for each of the venues you want licensed.

Amend/Notify Key Person changes on a Class 4 Operator's Licence .pdf (236k)* GC2
Use this form if you already have a Class 4 operator's licence and want to:

Add a key person

Remove a key person

Change the designation of an existing key person.

If adding or changing the designation of a key person, that person must also complete the

Class 3 & 4 Personal Information Form

.pdf (284k)

GC5

Make all other Amendments/Notifications to a Class 4 Operator's Licence.pdf (209k)* GC2A
Use this form if you already have a Class 4 operator's licence and want to:

Change your:
- authorised purpose(s)
- problem gambling policies
- method, system or policies for distribution of net proceeds
- governing document

Apply to accumulate funds

Make any other change that may affect your ability to comply with the Act or your class 4 operator's licence.

New Class 4 Venue Licence .pdf (306k)* GC3
Use this form if you are a club or other corporate society wanting to add another venue to your class 4 gambling licences.

Amend/Notify Key Person changes on a Class 4 Venue Licence .pdf (259k)* GC4
Use this form if you already have a Class 4 venue licence and want to:

Add a key person (venue manager, venue operator or director or shareholder of a venue operator company)

Remove a key person

Change the designation of an existing key person.

If adding or changing the designation of a key person, that person must also complete the Class 3 & 4 Personal Information Form .pdf (284k)* GC5

Make all other Amendments/Notifications to a Class 4 Venue Licence .pdf (269k)* GC4A
Use this form if you already have a Class 4 venue licence and want to:

Change the primary activity of the business at the venue

Remove any gambling equipment from the venue (no fee)

Add any gambling equipment to the venue

Change any gambling equipment at the venue

Increase the number of gaming machines that may be operated at the venue

Define the gambling area at the venue

Change any condition of the venue licence

Apply for an extension on the time class 4 gambling has not been conducted at the venue

Surrender the venue licence (no fee)

Dispose of gaming machines in the club’s or society’s storage (no fee).

Renew Class 4 Gambling Licence (Gaming Machine Account Summary) - Multi venue clubs and other societies .pdf (292k)* GC6
This form is to be used by multi venue clubs and societies to renew their Class 4 gaming licences.

Renew Class 4 Gambling Licence (Gaming Machine Account Summary) - Club renewals only .pdf (320k)* GC7
This form is to be used by single venue clubs to renew their Class 4 gaming licences.

Clubs Self-Assessment Review .pdf (120k)*

Non-Club Societies Self Assessment Review .pdf (130k)*

Harm Prevention and Minimisation Guidelines .pdf (70k)*
These guidelines will assist societies in self-checking levels of compliance against the Gambling Act 2003 and regulations relating to Harm Prevention and Minimisation.

If you require hard copies of any of these forms please contact the Gaming Compliance Unit.

Audited Financial Statements (for Class 4 Gambling)

The Gambling Act 2003 requires class 4 societies to provide audited financial statements to the Department of Internal Affairs within three months of the end of a society's financial year. The templates below will help clubs and corporate societies (class 4 operators) to prepare their financial statements and their forecast financial statements which are necessary to complete the Application to Renew Class 4 Operator's License and Venue Licence(s). Please note that these templates do not remove the need for judgement and consultation with your advisers when preparing your financial statements.

The following templates are for corporate societies:

Standard accounts - public societies .pdf (236k)*

Forecast standard accounts - public societies .pdf (134k)*

Forecast sign off - public societies .pdf (99k)*

The following templates are for clubs:

Standard accounts - clubs .pdf (261k)*

Forecast standard accounts - clubs .pdf (146k)*

Forecast sign off - clubs .pdf (99k)*

If you require hard copies of any of these forms please contact the Gaming Compliance Unit.

Standard Forms
The Secretary for Internal Affairs has issued standard forms relating to class 4 game rules and their use is mandatory. This means that corporate societies, venues or service providers cannot create and use their own versions, except where electronic copies can be generated in the same format as the standard forms and contain exactly the same information.

Form	What the Form is for	Relevant Game Rule(s)
Cash Clearance Details Report .pdf (37k)*	A machine-specific report to record all money removed from a gaming machine (i.e. cashbox and banknote clearances).	1, 23, 27, 33, 34, 62, 89,101
Cancelled Credit, Short Pays and Refills Report .pdf (51k)*	A machine-specific report to record: manual payments (“hand pays”) for credits awarded by individual gaming machines, and some jackpot systems any “short pay” correction payments manually paid out and all hopper refills put into gaming machines.	1, 23, 41, 46, 47, 49(g), 101(d)(ii)
Weekly Gaming Machine Profits Report .pdf (36k)*	A venue-specific report to be used only in certain circumstances after EMS connection (i.e. in the absence of the EMS-generated “Weekly Venue Activity” report) to record weekly turnover, wins and jackpot wins meter differences and to calculate GMP for weekly banking.	1, 23, 27, 55 – 58, 69, 81, 101 (these rules refer to the report previously known as the Weekly Gaming Machine Proceeds Report, which should continue to be used for the purposes indicated in those rules. Rule 126 relates specifically to this “post EMS” report.
Weekly Banking Reconciliation .pdf (24k)*	A venue-specific report to record details of individual bank deposits relating to the weekly GMP amount.	99, 125, 126(c), 127
Gaming Machine Analysis .pdf (35k)*	A machine-specific report to record and analyse gaming machine meters, meter differences, machine operation and associated cash transactions.	1, 23, 27, 37, 52, 58, 60 –64, 101, 128, 130
Gaming Machine Analysis .xls (426k) Note: This file is in Microsoft Excel 2003 format. If you do not have access to Excel 2003 or higher you may use the Excel file viewer to view, print and export the contents of this file.	This .xls 'Gaming Machine Analysis' form allows figures and other data to be input and automatically works out meter differences. Its use is not mandatory, but you are welcome to download and use it instead of the .pdf document if it suits your gaming machine operation. Please read the Gaming Machine Analysis Spreadsheet Instructions .pdf (24k)* before use.	1, 23, 27, 37, 52, 58, 60 –64, 101, 128, 130
Cashless Gaming Machine Analysis .pdf (33k)*	As for Gaming Machine Analysis, where gaming machines are connected to a “cashless” system.	1, 23, 27, 65, 79
Daily Jackpot Turnover Report .pdf (29k)*	A venue-specific report to be completed for “downloadable” jackpot systems to compare gaming machine hard turnover meters with jackpot controller turnover data.	1, 23, 27, 68, 71, 101(d)(v), 114, 119
Daily Jackpot Cancelled Credit Report .pdf (44k)*	A system-specific report for recording manual payments (“hand pays”) generated by “non downloadable” jackpot systems (i.e. those that do not download win information to individual gaming machines).	1, 23, 48, 49(d) & (h), 70, 77, 101(d), 120
Gambling Equipment Fault/Player Dispute Report .pdf (61k)*	A combined checklist and record of essential details in relation to: gambling equipment faults or malfunctions and/or player disputes in connection with gambling equipment operation.	23, 52, 73, 76, 84, 89, 91,110, 133
Unpaid Prize Report .pdf (28k)*	A report to record instances where, for any reason, a prize awarded by gambling equipment is not paid out.	23, 77, 84, 85, 86, 91, 133

Casino Gambling Only

Personal Information Application .pdf (239k)*
Application to be approved as an Associated Person (person who will have a significant influence) in a casino. Do NOT use this form for class 3 or class 4 gambling.

Company Information Application .pdf (270k)*
This form is used if your company is applying for Associated Person status in a casino.

Certificate of Approval Application .pdf (381k)*
Do not complete this application unless you have already been offered employment with a casino.

Group Commission Organiser/Representative Application .pdf (96k)*
This form is for those who wish to organise Group Commission Programmes in a New Zealand casino.

Group Commission Organiser/Representative Renewal of Approval Application .pdf (54k)*
This form is for those who wish to renew their approval to organise Group Commission Programmes in a New Zealand casino.

Note: The Personal Information, Certificate of Approval and Group Commission Organiser/Representative application forms are subject to the Criminal Records (Clean Slate) Act 2004. For more information see: Criminal Records (Clean Slate) Act 2004 (on www.justice.govt.nz). If further information is required then legal advice is recommended.

*These documents are in Adobe Acrobat (.pdf) format. You need to have the Adobe Acrobat Reader installed on your computer. You can download a free version from the Adobe site.


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Last updated: 11/11/2009