The Department of Internal Affairs

Te Tari Taiwhenua | Department of Internal Affairs

Building a safe, prosperous and respected nation



 

Forms to download

All forms are available in hard copy on request, from the relevant business group. See our contact details.

The majority of documents are available for download as pdf files. You need Adobe Acrobat Reader to view these documents, which can be downloaded for free from the Adobe site.


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Class 4 Gambling: Cashless Gaming Machine Analysis
Description: As for Gaming Machine Analysis, where gaming machines are connected to a "cashless" system.
File Format: Adobe Acrobat
File Size: 111k

Class 4 Gambling: Category A Renewals Gaming Machine Account Summary (GC7)
Description: This form is used by single-venue clubs to renew their Class 4 Gambling Licences. (April 2017)
File Format: Adobe Acrobat
File Size: 607k

Class 4 Gambling: Category A Renewals Gaming Machine Account Summary (GC7) Guidance Notes
Description: Guidance notes for GC7 form (above).
File Format: Adobe Acrobat
File Size: 600k

Class 4 Gambling: Cessation Guidelines
Description: Cessation of a Class 4 Gambling Operator's Licence (March 2015)
File Format: Adobe Acrobat
File Size: 174k

Class 4 Gambling: Cessation Pack
Description: Cessation of Class 4 Gambling Operator's Licence (April 2017)
File Format: Adobe Acrobat
File Size: 507k

Class 4 Gambling: Class 4 Operator's Licence Key Person Amendments/Notifications (GC2)
Description: 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; notify changes in circumstances as specified in section 54 of the Act. If adding or changing the designation of a key person, that person must complete the 'Class 3 & 4 Key Person Personal Information' form. (April 2017)
File Format: Adobe Acrobat
File Size: 595k

Class 4 Gambling: Class 4 Operator's Licence Non-Key Person Amendments/Notifications (GC2A)
Description: 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); change your problem gambling policies; change your method, system or policies for distribution of net proceeds; change your 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; provide details of disposal of gaming machines from society storage (no fee). (April 2017)
File Format: Adobe Acrobat
File Size: 616k

Class 4 Gambling: Class 4 Venue Licence Amendments & Non-Key Person Notifications (GC4A)
Description: Amendment to Licence, or notification under section 71 of the Gambling Act 2003, not related to Key Persons. (April 2017)
File Format: Adobe Acrobat
File Size: 779k

Class 4 Gambling: Class 4 Venue Licence Key Person Notifications (GC4)
Description: Notification under section 71 of the Gambling Act 2003, related to Key Persons. (April 2017)
File Format: Adobe Acrobat
File Size: 659k

Class 4 Gambling: Daily Jackpot Cancelled Credit Report
Description: 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).
File Format: Adobe Acrobat
File Size: 122k

Class 4 Gambling: Daily Jackpot Turnover Report
Description: A venue-specific report to be completed for "downloadable" jackpot systems to compare gaming machine hard turnover meters with jackpot controller turnover data.
File Format: Adobe Acrobat
File Size: 103k

Class 4 Gambling: Gambling Equipment Fault/Player Dispute Report
Description: 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.
File Format: Adobe Acrobat
File Size: 136k

Class 4 Gambling: Gaming Machine Analysis Report
Description: A machine-specific report to record and analyse gaming machine meters, meter differences, machine operation and associated cash transactions.
File Format: Adobe Acrobat
File Size: 113k

Class 4 Gambling: Gaming Machine Analysis Spreadsheet
Description: 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. 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.
File Format: Adobe Acrobat
File Size: 436k

Class 4 Gambling: Record Keeping for (Monthly) Gaming Operations
Description: 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. If you have any questions about using the spreadsheet, please contact Lance Daly, Team Leader Licensing Compliance: phone 09 362 7921 or email lance.daly@dia.govt.nz
File Format: Adobe Acrobat
File Size: 21k

Class 4 Gambling: Self-Assessment Review (Clubs)
Description: A self-checking tool to support clubs' compliance with the Gambling Act 2003. This document is completed by clubs prior to their compliance audit.
File Format: Adobe Acrobat
File Size: 292k

Class 4 Gambling: Self-Assessment Review (Non-Club Societies)
Description: A self-checking tool to support societies' compliance with the Gambling Act 2003. This document is completed by societies prior to their compliance audit.
File Format: Adobe Acrobat
File Size: 221k

Class 4 Gambling: Standard Financial Statements - Forecast Accounts Signoff (Clubs)
Description: Template to help clubs that operate Class 4 gaming machines to prepare forecast accounts sign-off necessary to complete their application to renew Class 4 operator's licence and venue licence(s).
File Format: Adobe Acrobat
File Size: 99k

Class 4 Gambling: Unpaid Prize Report
Description: A report to record instances where, for any reason, a prize awarded by gambling equipment is not paid out.
File Format: Adobe Acrobat
File Size: 100k

Class 4 Gambling: Weekly Banking Reconciliation Report
Description: A venue-specific report to record details of individual bank deposits relating to the weekly GMP amount.
File Format: Adobe Acrobat
File Size: 93k

Class 4 Gambling: Weekly Gaming Machine Profits Report
Description: 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.
File Format: Adobe Acrobat
File Size: 115k

Class 4 Gaming Machine Account Summary (Guidance Notes for GC6)
Description: April 2017
File Format: Adobe Acrobat
File Size: 253k

Exclusion Order (Problem Gamblers) Form
Description: Use this form to exclude patrons from your venue (under sections 309 and 310 of the Gambling Act 2003).
File Format: Adobe Acrobat
File Size: 57k

Financial Forecast Sign-Off Guidance for Societies and Clubs
Description: The Department requires an Independent Chartered Accountant with a Certificate in Public Practice to verify the financial information provided in the Gaming Machine Account Summary form (GC6) by performing specific procedures. This is known as an Agreed-upon procedures engagement. This engagement needs to be carried in accordance with APS -1 Statement of Agreed-upon procedures Engagement Standards and Guidelines of the New Zealand Institute of Chartered Accountants.
File Format: Adobe Acrobat
File Size: 92k

Self-assessment of your Class 4 club
Description: This self-assessment form is used by clubs and submitted, together with supporting evidence, with their application for a Three Year Licence.
File Format: Adobe Acrobat
File Size: 195k

Standard Accounts Template for Clubs who qualify as Tier 3 (Public Benefit Entitiy Reporting - Accrual)
Description: This template only relates to Clubs who qualify as a Tier 3, Public Benefit Entity under the new Accounting Standards Framework.
File Format: Adobe Acrobat
File Size: 78k

Three Year Licence - Guide to completing a self-assessment for your Class 4 Club
Description: This guide is used by clubs in the preparation of a self-assessment to be submitted with their application for a Three Year Licence.
File Format: Adobe Acrobat
File Size: 391k

Three Year Licence - Guide to completing a self-assessment for your Class 4 Society
Description: This guide is used by societies in the preparation of a self-assessment to be submitted with their application for a Three Year Licence.
File Format: Adobe Acrobat
File Size: 391k

Three year licence - Self-assessment of your Class 4 club
Description: This self-assessment form is used by clubs and submitted, together with supporting evidence, with their application for a Three Year Licence.
File Format: Adobe Acrobat
File Size: 195k

Three year licence - Self-assessment of your Class 4 society
Description: This self-assessment form is used by societies and submitted, together with supporting evidence, with their application for a Three Year Licence.
File Format: Adobe Acrobat
File Size: 195k


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