Required fields are marked with asterisks (*)

Lottery Licensing Eligibility Application

Name of Organization

Address

City

Postal Code

Telephone number

Email address

Incorporation Number

Registration Number

Please provide a current copy of letter from Canada Revenue Agency (letter recognizing charitable status under the Income Tax Act)

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide a copy of the most recent filing with Canada Revenue Agency.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide a copy of the Organization's Articles of Incorporation and/or Constitution or and/or any By-laws or Letters Patent.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

What year was the Organization established?

How many members comprise your bona fide membership?

Please list the Board of Directors and Executive (members with signing authority).

Describe the requirements that a person must meet in order to become a bona fide member of your organization.

Describe your organization's aim, objectives and services you provide.

Indicate the specific purpose(s) to which lottery proceeds will be used for.

Provice detailed outline of all programs/services with specific cost incurred for the current year and the previous year.

What is the Organization's financial year-end date?

Please provide a copy of the Organization's complete budget, covering the current twelve (12) month fiscal or calendar year, detailing how resources will be acquired and dispersed during this period.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide a copy of the Organization's previous year's financial statement.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Is the Organization currently licensed, or ever been licensed, in any other municipality to conduct lottery events?

Yes

Has the Organization ever had a licence revoked or refused?

Yes

Trust Account Information

Please note that a licensed organization must open and maintain a separate lottery trust account, designated as a trust account by the branch of a recognized financial institution, in the Province of Ontario. The designated lottery trust account must be in Canadian funds.

Name of Financial Institution

Address of Financial Institution

City of Financial Institution

Postal Code of Financial Institution

Phone Number of Financial Institution

Lottery Trust Account Number

Designated Member of Lotteries and Treasurer Information

A "Designated Member of Lotteries" is the member of the organization that will be responsible for keeping and maintaining records of all financial transactions pertaining to the licensed lottery activities. If the designated member changes, the Town of Kingsville must be notified immediately.

Designated Member Name

Designated Member Address

Designated Member Phone Number

Designated Member Email Address

Treasurer Name

Treasurer Address

Treasurer Phone Number

Treasurer Email Address

Declaration

I, the undersigned, declare that all information provided in and with this statement is factual and correct. I understand that the Licensing Officer makes a decision as to the eligibility of an organization in consultation with all policies as developed by the Alcohol and Gaming Commission of Ontario (AGCO). I understand that without eligible status, the Organization I am applying for will not be able to obtain any type of lottery licence as issued by the Licensing Officer on behalf of the AGCO.

Date

Name and Title of Principle Officer

Signature required.

Clear

Date

Name and Title of Principle Officer

Signature required.

Clear

Lottery Licensing Eligibility Application

Trust Account Information

Designated Member of Lotteries and Treasurer Information

I Want To...

Ask or Apply

Register or Pay

Request or Report