Microsoft Word Monte Carlo Licence Application doc



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Monte Carlo 

Lottery Licence Application 

 

 

Please allow two weeks for the processing of your application 



Applicant                

Applicant Information 

Organization Name: _________________________________________ 

Mailing Address: ___________________________________________ 

_________________________________________________________ 

City/Town: ________________________________________________ 

Province: ____________________ Postal Code: __________________ 

Phone: _____________________  Fax: ________________________ 

Email: __________________________________________________ 

 

 

1) Has your organization previously held 



  a lottery?                                                                     Yes      No 

 

    If Yes, what was the last licence number?      ___________________ 



 

 

  2) Is your organization a registered charity 



  with the Charities Directorate?                                    Yes      No 

 

    If Yes, what is the registration number?         ___________________ 



 

 

  3) Is your organization incorporated as a 



  non-profit organization?                                               Yes      No 

 

    If Yes, what is the incorporation number?       ___________________ 



 

 

Proposed Use of Proceeds 

Provide details as to how proceeds will be used: (Attach a separate sheet if necessary.) 

________________________________________________________________________________________________________________ 

________________________________________________________________________________________________________________ 

Monte Carlo Event(s) Location 

Name of the premises: _________________________________              The premises is owned by: ___________________________________ 

____________________________________________________              ________________________________________________________ 

Street Address: _______________________________________               

____________________________________________________              Rent:   $ _____________ per _____________                 

City/Town: ___________________________________________                  

Province: ____________________________________________               Is the premises a licenced liquor outlet?              Yes         No                       

To be signed by two Principal Officers of the Organization 

We certify that all information and documents supplied are correct and the organization has authorized us to make this application. 

Name: ___________________________________________________ 

Position: _________________________________________________ 

Address: _________________________________________________ 

_________________________________________________________ 

City/Town: ________________________________________________ 

Province: _________________  Postal Code: ____________________ 

Phone (W): ________________ Phone (H): ______________________ 

Signature: ________________________________________________ 

Date: ______________________ 

Email: ___________________________________________________ 

Name: ____________________________________________________ 

Position: ___________________________________________________ 

Address: ___________________________________________________ 

__________________________________________________________ 

City/Town: _________________________________________________ 

Province: __________________  Postal Code: ____________________ 

Phone (W): _________________ Phone (H): ______________________ 

Signature: __________________________________________________

Date: ______________________ 

Email: ____________________________________________________ 

 

  Organization RSN__________ 



   Property RSN      __________ 

Folder RSN    _____________ 

Entered       ______________ 

Office use 

only 

Personal Information contained on this form is collected by the Government of Newfoundland and Labrador and is 

protected under the Access to Information and Protection of Privacy Act, 2015. 



Monte Carlo Lottery Licence Application 

 

Event(s) Date(s) 

1) A single event to be held on _______________________________________ 

2) A series of events to be held during the period ____________________ to ____________________ for a total of __________ events. 



Event Information 

Admission 

Number of Tickets Printed ________________________ 

Ticket Price $ __________________________________ 

Is there a door prize or ticket draw associated 

with the purchase of the ticket?            Yes      No 

   If Yes, what is the value of the prize? $ _____________ 

   and describe the prize(s):  ____________________________ 

___________________________________________________ 



Wheel of Fortune                            Number of Wheels per event 

 

Ticket Wheel (cash or merchandise)           _________________ 



Crown and Anchor                                       _________________ 

Over and Under                                           _________________ 

Other Wheels (please describe below)        _________________ 

______________________                         _________________ 

______________________                         _________________ 

 

Monte Carlo Tables & Games                    Number of Tables/Games  

                                                                                   per event 

 

Roulette                                                             _________________ 



Blackjack                                                            _________________ 

Poker                                                                  _________________             

Horserace                                                           _________________ 

Other Games & Tables                                       _________________ 

(please describe below)             

______________________                                _________________ 

______________________                                _________________ 

______________________                                _________________ 

   

 

Ticket Raffle 



(Prize value per raffle cannot exceed $500)               Yes      No 

 

Lotteries Trust Account Information       



Event(s) Chair/Manager 

Name of Bank of Financial Institution: 

________________________________________________________ 

Type of account: __________________________________________ 

Person responsible for the event(s): 

____________________________________________________________ 

Phone (W): ___________________ Phone (H): ______________________ 

Gaming Supplier(s) 

 

Name of gaming supplier(s): 



___________________________________________________________ 

Licence 

Please indicate method of receiving your licence:  _______ Fax    ________ Email    __________ Mail 

The Licence will be mailed to your organization’s mailing address unless otherwise indicated. 

Applications can be dropped off at any Service Centre;  mailed to Consumer Affairs Division P.O. Box 8700 St. John’s, NL 

A1B 4J6;  faxed to (709) 729-6998,  or  (709) 637-2498, or emailed to: 

appsconsumeraffairs@gov.nl.ca

 

Consumer Affairs Toll Free Number:  1-877-968-2600, or Locally (Mount Pearl) at (709) 729-2660. 

Contact for Regional Offices: Corner Brook (709) 637-2445 (office)   Fax: (709) 637-2498. 

Reminder 

This application is only to be used if applying for a Monte Carlo Table or Monte Carlo game. 

The application must be signed by two principal officers of your organization. i.e. president, vice president, treasurer. 

Any changes or amendments to the licence shall be requested in writing. A licence is not transferable. 

A licence will not be issued for a Monte Carlo lottery event where the location of the event will be a commercial bar or tavern. 

Please read the General Rules and the rules for Monte Carlo lottery before submitting your application. See Schedule “F” 



 

         



September 2017   

 

 

Service NL  

 

             Government of Newfoundland & Labrador 

 

 

 

 

 

 

 

 

 

     http://www.servicenl.gov.nl.ca 

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