APPLICATION FORM FOR GAMING MACHINE TYPE LICENCE
1. Gaming machine details
Name of machine:
(max. 40 chars.)
Manufacturer:
Reserved licence number (if
applicable):
Class:
 TK - slot machine for casino (speelcasino)
(tick one box)
 TS – slot machine for arcade (speelautomatenhal)
 TH – slot machine for cafés/restaurants (hoogdrempelige horeca)
 TB – skill-based machine (behendigheidsautomaat)
2. Applicant details
Name of applicant:
Office address:
Post code:
City:
Country:
Phone:
Mailing address:
Postcode:
City:
Country:
Phone:
Contact officer:
Phone:
E-mail:
Fax:
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3. Test report and test laboratory
Test report reference nr.:
 BMM Spain Testlabs S.L. (Unipersonal)
Test laboratory:
(tick one box, see remarks)
 GLI Europe B.V.
 NMi Certin B.V.
 SIQ (Slovenian Institute of Quality and Metrology)
 Trisigma B.V.

The applicant authorises his test laboratory to represent him and act on his behalf during the licencing
process.
4. Authorization to apply for and attach official registration stickers


The applicant authorises the Nationale Stichting tot Exploitatie van Casinospelen in Nederland (= Holland
Casino) to apply for and attach registration stickers on his behalf.
The applicant authorises the following agent to apply for and attach registration stickers on his behalf.
Name of agent:
Company registration
(KvK) nr:
Address:
Postcode:
City:
Country:
Phone:
Contact officer:
Phone:
E-mail:
Fax:
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5. Attachments (can also be filled in by the test laboratory)

The following CDs/DVDs are attached (note the
mandatory requirements with regard to folder
structure, file format, image quality, and
similar)

The following inspection tools are attached:

The following other materials are attached:
6. Applicant signature
Name :
Position :
Date:
City:
Signature:
7. Signature of test laboratory, if authorised under 3.
Name :
Function:
Date:
City:
Signature:
Remarks

The type licence can only be applied for by the future licence holder, or by someone acting on his behalf. It is customary to authorise the testing
laboratory since it tends to speed up the application process. This is not mandatory; you may authorise someone else or do it yourself.

The list of five testing laboratories is not exclusive and others may be used; contact the Kansspelautoriteit beforehand if you wish to do so.

Gaming machines in the Netherlands need an official registration sticker (merkteken) similar to the number plate of a car. It must be attached by
the licence holder or someone acting on his behalf. It is customary to authorise Holland Casino for casino machines. It is never mandatory, and the
licence holder may authorize someone at a later date.

Personal information will be processed in the administration of the Kansspelautoriteit and will not be used for other purposes than the
implementation of the gambling legislation (Wet op de kansspelen) and other purposes as stipulated by law.

It is not mandatory to name a contact officer, but it is strongly recommended since it tends to speed up the application process.

This application form must be submitted as a signed and physical copy (not electronic) to the Kansspelautoriteit, Postbus 298, 2501 CG Den Haag.
Information: 070-302.1300 or [email protected].
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