Level 12, Newton Tower, Sir William Newton Street, Port Louis, Mauritius
Tel No.: 208 1582/ Fax No.: 213 1205
E-Mail: [email protected]
Application for Licence to conduct a Lottery
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Applicant Details
a. Corporate Applicant
Name of Company :…….............…………………………………………….........................…………………………
* Attach copies of company and trade licences.
Address :…............................................………………………………………………………………………………….
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Contact Person
Name :
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Tel. No. : …………................……………………….. Fax No. : ……........................………………………………
E-Mail : ………...............................................................................……………………………………………….
b. Sole Proprietor
Name
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NIC No. :…….......................………………………………………………………………………………....................
Address :…….............................................……………………………………………………………………………….
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Tel. No. : …………......……………….................……….. Fax No. : ………................…….………………………
E-Mail : ………............................................................................………………………………………………….
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Purpose
* Specify purpose for which the lottery is organised.
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GRA/AFLOT/1
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Products
* Specify products in respect of which the lottery is organised.
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Method of organisation
(Full details for distribution of lottery tickets/ scratch cards/ coupons)
* Please attach list of exchange points, if applicable
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Terms and Conditions of Participation including cost of SMS (if applicable)
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GRA/AFLOT/2
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Lottery Tickets/ Scratch Cards/ Coupons
* Attach specimen lottery ticket/ Scratch card/ Coupon
* Do not print lottery tickets/ Scratch cards/ Coupons until the application is approved.
Number of lottery tickets/ Scratch Cards/ Coupons to be printed : ………………..............
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Starting Serial No: …............……..……… Ending Serial No: .........................…..….…………. (if applicable)
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Duration of Competition
Starting Date : …………….…….................................................................….…………………………………….
Closing Date : …….......................................................................….….……………………………….………….
Date & Time of draw(s) : ……………..............................................................……..………………………….
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Place of Draw(s)
Location(s) : ..........................................…………………………..…………………………………………………….
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Prizes
* Attach quotations (Market value, including VAT, should be quoted).
* Include brand names, model and any condition that apply to the prizes.
* In case of motor vehicles and motorcycles/autocycles you will be required to bear the costs
of one year comprehensive insurance, registration duty and any other road charges.
List of prizes
Market Value (Rs)
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GRA/AFLOT/3
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*(Continue on separate sheet if necessary)
Total value of prizes :
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10 Certificate from applicant
Tick as appropriate
Yes
No
(i) Were you the holder of a licence which has been issued under the
Gambling Regulatory Authority Act/Gaming Act and which has been
revoked or cancelled?
*Applicable to Corporate Bodies
(ii) Has any director, manager or officer of your company been
convicted of any offence involving fraud or dishonesty within
the last 10 years ?
*Applicable to sole proprietor
(ii) Have you ever been convicted of any offence involving fraud or
dishonesty within the last 10 years ?
11 Applicant's Signature
I, ……………............................………………………………………………………………………………………………
(Name)
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(Capacity,for Corporate Applicant)
GRA/AFLOT/4
acting on behalf of …............................……………………………………………………………………………………..
(Name of company, if applicable)
apply for a licence to organise a lottery.
I hereby declare that the information given above and in the attached sheet(s) are true and correct.
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Authorised Signature/Signature
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Date
NB .The application form to be submitted at least one month prior to the proposed starting date of the lottery
Incomplete application will not be considered.
Please forward your completed application with supporting documentation to :
The Chief Executive
Gambling Regulatory Authority
Level 12, Newton Tower
Sir William Newton Street
PORT LOUIS
GRA/AFLOT/5
GRA/AFLOT/6