Gaming Machine Licence Application
Gaming Machine Licence Application - SA.gov.au
Gaming Machine Licence Application - SA.gov.au
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Appendix A cont.– Transfer <strong>Licence</strong> <strong>Application</strong>Please photocopy if there is not enough spacePerson 22aSurnameGiven Name(s)2bDate of Birth/ / Female Male2c Category of approval Tick one or more boxes Licensee Director Shareholder Committee Member Adult Trust Beneficiary2d Previous Approval Is this person currentlyapproved ? Yes NoID No:(Note: A completed PID is required if the person hasnever been approved or had a previous approval thatceased more than 6 months ago)2eCurrent ResidentialAddressStreet NumberStreet NameSuburb / town:Postcode:2fContact DetailsPhone:Email:
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