Promoters application - Office for Recreation and Sport

- 2 -Q2. Have you ever been convicted of an offence (other than a traffic offence) or are anycourt proceedings pending?(Note - you are required to provide a National Police Clearance Certificate with yourapplication). If yes, please provide details. Yes No______________________________________________________________________Q3. Have you ever been suspended or disqualified from practising or carrying on anoccupation, trade or business in this State or elsewhere? If yes, please provide details.Yes No______________________________________________________________________Q4. Are you an undischarged bankrupt or subject to a Composition, Deed, Scheme ofArrangement with or for the benefit of creditors? If yes, please provide details.Yes No______________________________________________________________________Q5. Have you during the last 5 years, been a director of a Body Corporate that has beenwound up for the benefit of creditors? If yes, please provide details. Yes No______________________________________________________________________SECTION 3APPLICATION DECLARATIONI, the applicant described in this form, do solemnly and sincerely declare that:• I have read the Boxing and Martial Arts Act 2000 and Regulations and understand mylegal obligations if the Promoters Licence is granted; and• the contents of this Application Form and attachments are true and correct and that Iunderstand that providing false or misleading information is an offence under Section18 of the Boxing and Martial Arts Act 2000.I also authorise the Minister for Recreation, Sport and Racing to make any inquiriesnecessary for the purpose of determining this application.I acknowledge that information contained in this form may be made available to interstaterecognised authorities.Signature: _____________________________________________ _______________(of Applicant)(date)