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Services › Casino and Non-Casino Gaming › Class 4 Gambling Forms
Class 4 gambling forms and guidelines are available for you to open, print out or download as PDF* and XLS** files.
- Class 4 Operator's Licence Forms
- Class 4 Venue Licence (and Expenses) Forms
- Class 4 Licence Renewal Forms
- Standard Gaming Machine Forms
- Harm Prevention and Exclusion Order Forms
- Self-Assessment Reviews
- Record Keeping for Gambling Operations
- Audited Financial Statements
- Cessation of Class 4 Licences
Class 4 Operator's Licence Forms
| Form | Summary | Updated | |
|---|---|---|---|
| Application for a New Class 4 Operator's Licence
(PDF, 129K)* GC1 - Declaration |
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 also need to complete the Application for a New Class 4 Venue Licence (PDF, 87k)* GC3 form for each of the venues you want licensed, and provide a Class 3 & 4 Key Person Application - Personal Information (PDF, 284K)* GC5 form completed by each key person in respect of the club / corporate society / venue. More information about Class 4 Licensing Criteria. | March 2011 | |
| Class 4 Operator's Licence - Key Person Amendments / Notifications
(PDF, 66K)* GC2 - Declaration |
Amendment to Licence, or notification under section 54 of the Gambling Act 2003, related to Key Persons. Use this form if you 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 complete the Class 3 & 4 Key Person Application - Personal Information (PDF, 284K)* GC5 form. | March 2011 | |
| Class 4 Operator's Licence - Non-Key Persons Amendments / Notifications
(PDF, 61K)* GC2A - Certification |
Amendment to Licence, or notification under section 54 of the Gambling Act 2003, not related to Key Persons. Use this form if you 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. | October 2010 | |
| Class 3 & 4 Key Person Application - Personal Information
(PDF, 284K)* GC5 - Declaration |
Personal Information Form for Class 3 and Class 4 gambling. | August 2010 |
Class 4 Venue Licence (and Expenses) Forms
| Form | Summary | Updated | |
|---|---|---|---|
| Application for a New Class 4 Venue Licence
(PDF, 87K)* GC3 - Declaration |
Use this form if you are a club or other corporate society wanting to add a first or subsequent venue to your Class 4 Operator's Licence. You also need to provide a Class 3 & 4 Key Person Application - Personal Information (PDF, 284K)* GC5 form completed by each key person in respect of the venue. | February 2011 | |
| Class 4 Venue Licence - Key Persons Notifications
(PDF, 66K)* GC4 - Declaration |
Notification under section 71 of the Gambling Act 2003, related to Key Persons. Use this form if you want to add a key person (venue manager, venue operator or director, shareholder, receiver or liquidator 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 complete the Class 3 & 4 Key Person Application - Personal Information (PDF, 28K)* GC5 form. | February 2011 | |
| Class 4 Venue Licence - Amendments and Non-Key Person Notifications
(PDF, 81K)* GC4A - Certification |
Amendment to Licence, or notification under section 71 of the Gambling Act 2003, not related to Key Persons. Use this form if you 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 from the club’s or society’s storage (no fee). | October 2010 | |
| Class 4 Venue Costs Schedule
(XLS, 28K)** |
The schedule, which is used to claim Class 4 Venue Costs, forms part of every Class 4 Venue Agreement. It must be used by all societies when assessing the venue costs associated with a Class 4 gambling operation. It is set to 15% GST. More information about Venue Expenses. | October 2010 |
Class 4 Licence Renewal Forms
| Form | Summary | Updated | |
|---|---|---|---|
| Renew Class 4 Gambling Licence (Gaming Machine Account Summary): Multi Venue Clubs and Other Societies
(PDF, 124K)* GC6 - Certification |
This form is used by multi venue clubs and other societies to renew their Class 4 Gambling Licences. | April 2011 | |
| Renew Class 4 Gambling Licence (Gaming Machine Account Summary): Single Venue Clubs
(PDF, 118K)* GC7 - Certification |
This form is used by single venue clubs to renew their Class 4 Gambling Licences. | April 2011 |
Standard Gaming Machine Forms
The Secretary for Internal Affairs has issued standard forms relating to Class 4 Game Rules. 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 | Summary | Relevant game rules | |
|---|---|---|---|
| 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) | |
| 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 | |
| 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 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 | |
| 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 | |
| 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 | |
| Gaming Machine Analysis Report
(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 Spreadsheet
(XLS, 426K)** |
In response to a number of requests, we have produced the Gaming Machine Analysis Report in a simple Microsoft Excel spreadsheet that allows figures and other data to be input and automatically works out meter differences. It is essentially the same as the PDF version but has some minor additional functionality (e.g. highlighting the difference between actual and calculated hopper movement). You are welcome to download and use it instead of the PDF version if it suits your gaming machine operation. Please read the Spreadsheet Instructions (PDF, 24K)* before use. If you have any questions or experience any difficulties using it, please contact Senior Inspector Technical David Chatwin - direct dial (03) 353 8308 or email david.chatwin@dia.govt.nz. | 1, 23, 27, 37, 52, 58, 60–64, 101, 128, 130 | |
| 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 | |
| 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 | |
| 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, 126 |
Harm Prevention and Exclusion Order Forms
| Form | Summary | Updated | |
|---|---|---|---|
| Harm Minimisation Venue Assessment Checklist
(PDF, 64K)* |
Inspectors may use this checklist for evaluating compliance with current Harm Prevention and Minimisation requirements for Class 4 venues. | December 2011 | |
| Harm Prevention and Minimisation Guidelines | These guidelines will assist societies in self-checking levels of compliance against the Gambling Act 2003 and regulations relating to harm prevention and minimisation. More information about Harm Prevention, Harm Minimisation and Responsible Gambling. | December 2011 | |
| Exclusion Order (Problem Gamblers) Form
(PDF, 20K)* |
Use this form to exclude patrons from your venue (under sections 309 and 310 of the Gambling Act 2003). More information about Problem Gambling. | December 2005 | |
| Exclusion Order (Problem Gamblers) Guidelines | Please read these guidelines for more information about issuing exclusion orders. | December 2005 |
Self-Assessment Reviews
Self-assessment tools, based on the Department's own audit checklist, provide societies and clubs with an ability to test their own levels of compliance of their gaming machine operations with the requirements of the Gambling Act 2003, related regulations, licence conditions and game rules; identify areas where internal policies, systems and procedures should be developed, enhanced or strengthened; and put measures in place immediately to rectify any areas of non-compliance identified.Completion of Self-Assessment Reviews does not limit the Secretary for Internal Affairs or any Gambling Inspector in the exercise of their functions and powers under the Gambling Act 2003.
| Form | Summary | Updated | |
|---|---|---|---|
| Self-Assessment Review for Clubs
(PDF, 211K)* GC-SARC1 |
A self-checking tool to support clubs' compliance with the Gambling Act 2003. This document is completed by clubs prior to their compliance audit. | December 2011 | |
| Self Assessment Review for Non-Club Societies
(PDF, 150K)* GC-SARNCS1 |
A self-checking tool to support societies' compliance with the Gambling Act 2003. This document is completed by societies prior to their compliance audit. | December 2011 |
Record Keeping for Gambling Operations
The following spreadsheet provides an example for clubs of record keeping for gambling operations on a monthly basis.It will help you to:
- identify funds available for Authorised Purposes each month;
- monitor the percentage of distributed Authorised Purposes on a monthly basis;
- understand the difference between Authorised Purposes and the Direct Costs of Gaming;
- avoid over-distribution of Authorised Purposes;
- and complete the renewal application.
| Form | Summary | Updated | |
|---|---|---|---|
| Record Keeping for (Monthly) Gambling Operations
(XLS, 30K)** |
Clubs can update this spreadsheet with data from the start of the financial year. You can add more Authorised Purposes (AP) that correspond to the club's gambling licence. Total boxes and AP percentages will be calculated automatically if the formula stays the same. More information about the Record Keeping Spreadsheet. | June 2010 |
Audited Financial Statements
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 following templates 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 Licence and Venue Licence(s).
These templates do not remove the need for judgement and consultation with your advisers when preparing your financial statements.
| Templates for Public / Corporate Societies | Templates for Clubs |
|---|---|
| Standard Accounts - Societies
(PDF, 236K)* |
Standard Accounts - Clubs
(PDF, 261K)* |
| Forecast Standard Accounts - Societies
(PDF, 134K)* |
Forecast Standard Accounts - Clubs
(PDF, 146K)* |
| Forecast Sign Off - Societies
(PDF, 99K)* |
Forecast Sign Off - Clubs
(PDF, 99K)* |
Cessation of Class 4 Licences
| Form | Summary | Updated | |
|---|---|---|---|
| Cessation Pack: Cessation of Class 4 Operator's Licence
(PDF, 356K)* |
Clubs and societies may wish to use this pack, which contains the minimum information (in terms of section 111 (1) (b) of the Gambling Act 2003) required for the cessation of a Class 4 Operator's Licence. More information about Compliance, Investigations and Audits. | September 2007 | |
| Cessation Review Guidelines | These guidelines will assist clubs and societies in the winding up of their gaming machine operations, and the subsequent review of their final set of accounts. | September 2007 |
*You need Adobe Reader installed on your computer to view these forms. If you are unable to open the forms we recommend you get the latest version of Adobe Reader. You can download and install Acrobat Reader for free from the Adobe website.
**You need Microsoft Excel 2003 installed on your computer to view these files. 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.
Unable to download or access our forms? Contact the Gambling Compliance Group and request printed copies.
