National Library of New Zealand
Harvested by the National Library of New Zealand on: Jul 3 2006 at 4:42:47 GMT
Search boxes and external links may not function. Having trouble viewing this page? Click here
Close Minimize Help
Wayback Machine

New Zealand Department of Internal Affairs : Services : Forms Skip to Access Key assignments for this site
Skip to the content of this page
Skip to other pages in this section
Skip to site wide navigation
Skip to links for help with this site
Logo of the New Zealand Department of Internal Affairs

Home

Services

About us

What's new

Legal

Forms

Resources

Other pages in this section

Gambling

Gambling Act 2003

Casinos

Gambling in Pubs and Clubs (Class 4)

Problem Gambling

Compliance Investigations and Audits

Infringement Notices

Funding For Community Groups

Housie, Lotteries, Games of Chance, Prize Competitions and Instant Games (Class 1, 2 and 3 Gambling)

Gambling Technical Equipment

Prohibited Gambling

Electronic Monitoring System (EMS)

Forms

Fact Sheets (Gambling Act 2003)

How to Contact Us

News, Press Releases & Consultation

Related Links

Return to top of page Content area

Forms


Click on the links below to open, print out or download pdf* versions of the following gambling licence application and information forms. For hard copies of these forms please contact the Gaming Compliance Unit:

Class 3 Gambling Only

  • Calcutta Auction Record Sheet 48k* - The Calcutta Auction Record Sheet is to be filled out during the auction and is to be attached to the Class 3 Audit and Prize Statement.
If you require a hard copy of any of these forms please contact the Gaming Compliance Unit.
  • Link here to the Game Rules that accompany these forms.
Licensed Promoter Licensing Forms:


Class 3 & 4 Gambling


Please Note: The Personal Information Form is subject to the Criminal Records (Clean Slate) Act 2004. For more information see:
Criminal Records (Clean Slate) Act 2004 (on www.justice.govt.nz). If further information is required then legal advice is recommended.


Class 4 Gambling Only

  • Class 4 Venue (New) 160k* - Application for a new Venue Licence for Class 4 gambling (updated 29/05/2006).
  • Class 4 Venue (Amend) 167k* - Application to amend a Venue Licence for Class 4 gambling (updated 29/05/2006). Note: Base Approval Number (BAN) is required for QCOM ready machines only.
Renewal of Class 4 gaming licences:

Audited Financial Statements (for Class 4 Gambling)

The
Gambling Act 2003 requires class 4 societies to provide audited financial statements to the Department of Internal Affairs within three months of the end of a society's financial year. The templates below will help clubs and corporate societies (class 4 operators) to prepare their financial statements and their forecast financial statements which are necessary to complete the Application to Renew Class 4 Operator's License and Venue Licence(s). Please note that these templates do not remove the need for judgement and consultation with your advisers when preparing your financial statements.

The following templates are for corporate societies:

The following templates are for clubs: If you require a hard copy of any of these forms please contact the Gaming Compliance Unit.


Standard Forms (for use pre-EMS connection)

The Secretary for Internal Affairs has issued standard forms relating to class 4 game rules and their use is mandatory. This means that corporate societies, venues or service providers cannot create and use their own versions, except where electronic copies can be generated in the same format as the standard forms and contain exactly the same information.

Note: Use these forms if your venue has not yet been connected to the Electronic Monitoring System (EMS). If your venue has already been connected to EMS please use the 'Standard Forms (for use post-EMS connection)' in the next section.

Form (for use pre-EMS connection)What the Form is forRelevant Game Rule(s)
Cash Clearance Details Report 136k*A machine-specific report to record all money removed from, or put into a particular gaming machine (i.e. cashbox and banknote clearances, hopper refills).26, 30, 37, 39, 40, 48, 69, 98
Cancelled Credit and Short Pays Report 134kA machine-specific report to record hand pays initiated by or through individual gaming machines, and any “short pays” manually paid out.26, 30, 53, 54, 56, 58, 60, 69, 85
Cancelled Credit, Short Pays & Refills Report 184k*As per the Cancelled Credit and Short Pays Report, but it has provision to record hopper refills as an alternative to recording them on the Cash Clearance Details Report.26, 30, 48, 53, 54, 56, 58, 60, 69, 85
Weekly Gaming Machine Proceeds Report 140k*A venue-specific report to record weekly “turnover minus total wins” meter differences for up to four gaming machines per form to determine banking amount. 26, 30, 63, 64, 65, 66, 77, 90
Note: Also referred to in Conditions 4 and 5 of Class 4 Venue Licence Conditions
Weekly Gaming Machine Proceeds Summary Report 133k*A venue-specific report to:
  • summarise a number of Weekly Gaming Machine Proceeds Report and/or
  • adjust banking amount to account for jackpot prizes not recorded as “total wins” and/or
  • adjust for any unpaid prizes and/or
  • reconcile interim banking.
26, 63, 64, 85, 90, 94, 95, 98
Note: Also referred to in Conditions 4 and 5 of Class 4 Venue Licence Conditions
Monthly Machine Analysis 150k*

(Revised version 10/9/2004 - see 'Erratum' above)
A machine-specific report to:
  • record and analyse meter differences, machine operation and associated cash transactions
  • determine/confirm monthly gaming machine profit.
26, 30, 60, 67, 68, 69, 70, 71
Cashless Gaming Machine Analysis 152k*As for Monthly Machine Analysis, where machines are connected to a “cashless” system.26, 30, 73
Daily Jackpot Turnover Report 129k*A venue-specific report to be completed for certain jackpot systems to compare gaming machine meter incrementation with jackpot system data. 26, 30, 76, 79
Daily Jackpot Cancelled Credit Report 175k*A system-specific report for recording hand-pays generated by certain jackpot systems where win information is not downloaded to individual gaming machines.26, 55, 56, 78, 85
Weekly Jackpot System Analysis: A system-specific report for analysing and verifying activity and performance of certain jackpot systems.
(There are 3 separate versions of this form, depending upon the number of levels that the jackpot system has).
26, 65, 77, 79
Gambling Equipment Fault/Player Dispute Report 153k*A combined “checklist” and report to record observed or reported equipment faults or malfunctions and details of player “disputes” in connection with equipment operation.21, 26, 60, 81, 84, 93, 98, 100


Standard Forms (for use post-EMS connection)

The Secretary for Internal Affairs has issued standard forms relating to class 4 game rules and their use is mandatory. This means that corporate societies, venues or service providers cannot create and use their own versions, except where electronic copies can be generated in the same format as the standard forms and contain exactly the same information.

Note: Use these forms if your venue has already been connected to the Electronic Monitorin System (EMS). If your venue has not yet been connected to EMS please use the 'Standard Forms (for use pre-EMS connection)' in the previous section.

Form (for use post-EMS connection)What the Form is forRelevant Game Rule(s)
Cash Clearance Details Report 89k*A machine-specific report to record all money removed from a gaming machine (i.e. cashbox and banknote clearances).1, 23, 27, 33, 34, 62,
89,101
Cancelled Credit, Short Pays and Refills Report 133k*A machine-specific report to record:
  • Manual payments (“hand pays”) for credits awarded by individual gaming machines, and some jackpot systems
  • any “short pay” correction payments manually paid out and
  • all hopper refills put into gaming machines.
1, 23, 41, 46, 47, 49(g), 101(d)(ii)
Weekly Gaming Machine Profits Report 91k*A venue-specific report to be used only in certain circumstances after EMS connection (i.e. in the absence of the EMS-generated “Weekly Venue Activity” report) to record weekly turnover, wins and jackpot wins meter differences and to calculate GMP for weekly banking. 1, 23, 27, 55 – 58, 69, 81, 101 (these rules refer to the report previously known as the Weekly Gaming Machine Proceeds Report, which should continue to be used for the purposes indicated in those rules.

Rule 126 relates specifically to this “post EMS” report.
Weekly Banking Reconciliation 49k*A venue-specific report to record details of individual bank deposits relating to the weekly GMP amount99, 125, 126(c), 127
Gaming Machine Analysis 80k*A machine-specific report to record and analyse gaming machine meters, meter differences, machine operation and associated cash transactions 1, 23, 27, 37, 52, 58, 60 –64, 101, 128, 130
Cashless Gaming Machine Analysis 74k*As for Gaming Machine Analysis, where gaming machines are connected to a “cashless” system.1, 23, 27, 65, 79
Daily Jackpot Turnover Report 89k*A venue-specific report to be completed for “downloadable” jackpot systems to compare gaming machine hard turnover meters with jackpot controller turnover data. 1, 23, 27, 68, 71, 101(d)(v), 114, 119
Daily Jackpot Cancelled Credit Report 104k*A system-specific report for recording manual payments (“hand pays”) generated by “non downloadable” jackpot systems, i.e. those that do not download win information to individual gaming machines).1, 23, 48, 49(d) & (h), 70, 77, 101(d), 120
Gambling Equipment Fault/Player Dispute Report 105k*A combined checklist and record of essential details in relation to:
  • gambling equipment faults or malfunctions and/or
  • player disputes in connection with gambling equipment operation.
23, 52, 73, 76, 84, 89, 91,110, 133
Unpaid Prize Report 54k*A report to record instances where, for any reason, a prize awarded by gambling equipment is not paid out.23, 77, 84, 85, 86, 91, 133


Casino Gambling Only

Associated Persons
Note: The Personal Information Form is subject to the Criminal Records (Clean Slate) Act 2004. For more information see:
Criminal Records (Clean Slate) Act 2004 (on www.justice.govt.nz). If further information is required then legal advice is recommended.


Certificates of Approval
*These documents are in Adobe Acrobat (.pdf) format. You need to have the Adobe Acrobat Reader installed on your computer. You can download a free version from the Adobe site.

Return to top of page
Links for help with this site

Site map

Search

Help

Contact us

Email us

Govt.nz

Return to top of page

Last updated: 30/06/2006