Sites - Premises Forms
Forms relating to a licensed premises can be downloaded below.
| Title | Date | File type | Link | P |
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| Form 75A Monthly Self Assessment Checklist - Hotels | 1 July 2005 | download (125 K) |
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| Monthly self assessment checklist to be completed by Hotels | ||||
| Form 75B Monthly Self Assessment Checklist - Clubs | 1 July 2005 | download (155 K) |
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| Monthly self assessment checklist to be completed by Clubs | ||||
| Form 3a - Gaming Machine Licence Application (Individual) | 15 June 2004 | download (175 K) |
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| To be completed by an individual who wish to apply for a gaming machine licence for a Hotel/Tavern. | ||||
| Form 3b - Gaming Machine Licence Application (Club) | 15 June 2004 | download (140 K) |
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| To be completed by the authorised executives who wish to apply for a gaming machine licence for a Club. | ||||
| Form 3c - Gaming Machine Licence Application (Body Corporate) | 15 June 2004 | download (255 K) |
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| To be completed by a company who wish to apply for a gaming machine licence for a Hotel/Tavern. | ||||
| Form 3e - Application for Renewal of a Gaming Machine Licence (Individual) | 16 May 2005 | download (130 K) |
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| To be completed by an individual for a Category 1 (Hotel) who wish to renew their gaming machine licence. | ||||
| Form 3f - Application for Renewal of a Gaming Machine Licence (Body Corporate) | 21 June 2005 | download (145 K) |
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| To be completed by a Category 1 (Hotel) or Category 2 (Club) body corporate who wish to renew their gaming machine licence. | ||||
| Form 7 - Application for a Gaming Machine Increase | 15 June 2004 | download (255 K) |
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| To be completed by Gaming Machine Licensees (Body Corporate or Individual) who wish to apply for an increase in the approved number of gaming machines for the site. | ||||
| Form 7a - Application for a Gaming Machine Decrease | 15 June 2004 | download (270 K) |
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| Application to decrease the approved number of gaming machinese granted to a licensee. | ||||
| Form 7b - Relocation of a Gaming Machine Area | September 2006 | download (25 K) |
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| This form is to be completed by Gaming Machine Licensees who wish to apply for a relocation of gaming machines. This form and the associated fee MUST be lodged with your Licensed Monitoring Operator. | ||||
| Form 11 - Notify Changes in Executive/Secretary | 26 July 2004 | download (60 K) |
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| To be completed by a Gaming Machine Licensee (Body Corporate) whenever there is a change in the Secretary or an Executive Officer of the Body Corporate. Each person that is newly appointed to the Body Corporate must also complete a Personal Probity(Short) Form for the appropriate category. | ||||
| Personal Probity (Short) Form - Category 1 Gaming Licensees (Hotels/Taverns) | 10 June 2005 | download (115 K) |
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| To be completed by each person that is newly appointed to the Body Corporate. | ||||
| Personal Probity (Short) Form - Category 2 Gaming Licensees (Clubs) | 10 June 2005 | download (125 K) |
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| To be completed by each Executive Officer or Member of the Management Committee of a Club. | ||||
| Form 11b - Notification of Current Executive | 26 July 2004 | download (240 K) |
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| This form is to be completed by the Gaming Machine Licensee (Body Corporate) and submitted in conjunction with the Application for Renewal of the licence only. | ||||
| Form 12 - Surrender of Gaming Machine Licence | 15 June 2004 | download (235 K) |
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| Notification requesting Surrender of Gaming Machine Licence. | ||||
| Form 20b - Affidavit - Gaming Machine Licence | 15 June 2004 | download (185 K) |
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| Must be completed by applicants for and the holders of a gaming machine licence. A new affidavit must be completed and submitted each time there is a change in circumstances as detailed in the previous affidavit. | ||||
| Form 30 - Payout Refusal Report | 1 August 2005 | download (55 K) |
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| To be used by a Club or Hotel to record the details and indicate further action required when a Gaming Machine site refuses to make a payout to a patron. | ||||
| Form 39 - Manual Payments Register | 16 June 2004 | download (590 K) |
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| To record manual payments made to patrons by Clubs and Hotels from gaming machines. | ||||
| Form 40 - Cash Clearances Report | 13 June 2003 | download (485 K) |
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| To be used by Clubs and Hotels to record cash cleared from Gaming Machines. | ||||
| Form 41 - Gaming Machine Performance Record Part 1 | 13 June 2003 | download (480 K) |
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| To be used by Clubs and Hotels to record daily Gaming Machine performance details. | ||||
| Form 41 - Gaming Machine Performance Record Part 2 | 11 November 2004 | download (30 K) |
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| To be used by Clubs and Hotels to record daily Gaming Machine performance details. | ||||
| Form 42 - Monthly EGM Reconciliation Report (Hotel) | 13 June 2003 | download (105 K) |
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| To be used by Hotels only to record and reconcile Gaming Machine details for any given month. | ||||
| Form 42 - Monthly Reconciliation Report (Club) | 31 July 2008 | download (50 K) |
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| To be used by Clubs only to record and reconcile Gaming Machine details for any given month. A copy of this form must be attached to the Form 61 and retained on the premises. | ||||
| Form 45 - Appeal decision of Qld Gaming Commission | 15 June 2004 | download (200 K) |
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| To be completed where an applicant or licence holder is aggrieved of a decision in relation to an application determined by the Queensland Gaming Commission. | ||||
| Form 57 - Acquisition/Replacement/Disposal of Gaming Machines | 1 July 2003 | download (195 K) |
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| To be completed whenever a gaming machine is to be acquired, replaced or disposed of and such as may need to be accompanied by an application for an increase or decrease or surrender of licence. | ||||
| Declaration - Destruction of Gaming Machines | 16 November 2004 | download (165 K) |
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| EGM Acquisition/Replacement/Disposal Arrangements | 1 July 2003 | download (20 K) |
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| This document should be read in conjunction with Form 57 (Application for Acquisition/Replacement/Disposal of Gaming Machines. It describes the conditions under which approvals are given for the acquisition, replacement and disposal of gaming machines. | ||||
| Form 58 - Register of Gaming Machines | 31 July 2008 | download (115 K) |
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| Register of all Gaming Machines owned or leased (including sub-leased and hire purchase or other contractual bailment) by a Licensee. | ||||
| Form 61 - Monthly Variances Record | 1 April 2005 | download (35 K) |
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| To be used by Clubs to record monthly variances in Gaming Machines for any given month. This form must be prepared and certified every month by the designated (gaming) nominee. | ||||
| Form 70 - Application for Increase in Gaming Hours | 15 June 2004 | download (310 K) |
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| To be completed by a licensee that wishes to apply for an increase in the approved hours of gaming. | ||||
| Form 74 - Statement of Payment of Benefits | 1 May 2005 | download (95 K) |
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| To be completed by clubs setting out details of benefits provided to certain persons during the financial year and to be submitted annually along with the club's audit report on gaming operations and financial statements. | ||||
| Community Benefit Statement | 18 May 2001 | download (125 K) |
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| To be completed by clubs who operated 51 or more gaming machines in a financial year. | ||||
| Form 76 - Statement against Minimum Requirements for a Gaming-Related Compliance Program | 29 July 2005 | download (45 K) |
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| To be completed by gaming machine licence applicants and lodged with application. | ||||
| Code of Practice Commitment Checklist | September 2007 | download (35 K) |
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| P | Also available in hardcopy |
For further information:
- (07)3872 0999
- info@qogr.qld.gov.au
Last reviewed 19 August 2008
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