Application Form |

This application form will take approximately 10 minutes to complete.

You will need to upload a certified copy of your current licence, permit or authority that authorises you as a bookmaker or to conduct a wagering business to complete this form (certified by a lawyer, Justice of the Peace or Commissioner for Declarations) so please make sure you have a scanned copy before you start.
Is this your first time applying for authority to use Queensland race information?
Is this the first time?*
- Yes
- No
Have you previously or do you currently hold an authority to use Queensland race information in your name, in the name of another entity, or otherwise in connection with your bookmakers licence or other authority?
Have you previously or do you currently hold an authority to use Queensland race information in your name, in the name of another entity, or otherwise in connection with your bookmakers licence or other authority?*
- Yes
- No
Please provide details*
APPLICATION FEE

An application fee of $250 is payable to Racing Queensland for all first-time applicants. Please make payment of the application fee by direct debit using the following bank details:
Account name: Racing Queensland
BSB: 084-004
Account number: 155 292 095
Reference: Applicant’s name
What Best Describes You?
Please Select:
Individual - if you are applying as an individual, (e.g. you are licensed in your individual name as a bookmaker)

Partnership - if you are applying on behalf of a partnership

Corporation / Sole Trader - if you are applying on behalf of a corporation or if you are a sole trader
Application Type*
- Individual
- Partnership
- Corporation / Sole Trader
Applicant Details
Title*
Title*
Applicant Name*
Trading Name(s)*

(Please list all trading names used by the Applicant to accept bets. If none, put 'N/A'.)
ABN
ABN*
ACN*
Members of Partnership*
Postal Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Telephone

Please include area code
Mobile*
Email
Email*
Date of Incorporation*
DD slash MM slash YYYY
State of Incorporation*
Nominated Contact Person

(If different to applicant)

Details of wagering licence, permit or authority held by the Applicant
Add a licence for each Licensing Authority that granted the Applicant its bookmaker’s licence or a licence to conduct a wagering business.
Are you licensed by the Queensland Racing Integrity Commission?*
- Yes
- No
Place where licences were granted*
- Multiple or Single licence issued in Australia
- Single licence issued in another country
Name of Licensing Authority*

A Licence Authority is an organisation that has granted the applicant a bookmaker's licence or licence to conduct a wagering business.
Name Appearing on licence, permit or authority*

If the name of the Applicant is not the same as the name on the licence, permit or authority - this application will not be granted.
Name Appearing on licence, permit or authority*

If the name of the Applicant is not the same as the name on the licence, permit or authority - this application will not be granted.
Country*
Expiry Date*
DD slash MM slash YYYY
Licence Number*
Licence Number*
Expiry Date*
DD slash MM slash YYYY
Legislation Details*

Legislation under which applicant is authorised as a bookmaker or to conduct a wagering business
Multiple Licences if entered
Australian Issued Licence Details
Name of Licensing Authority

A Licence Authority is an organisation that has granted the applicant a bookmaker's licence or licence to conduct a wagering business.
Name appearing on licence, permit or authority

The name of the Applicant in section 1, 2 or 3 (as applicable) must be the same as the name appearing on the licence, permit or authority.
State Issued
Licence Number
Expiry Date
DD slash MM slash YYYY
Add Another LicenceRemove
List any conditions or restrictions attached to the licence / authority or set out in the relevant legislation
e.g. types of wagering, location etc...
List any conditions or restrictions attached to the licence / authority or set out in the relevant legislation
e.g. types of wagering, location etc...
Attachments*
Drop files here or

Accepted file types: jpg, tiff, png, pdf, Max. file size: 50 MB.
Please upload a certified copy of the applicant's current licence, permit or authority that authorises the applicant as a bookmaker or to conduct a wagering business (certified by a lawyer, Justice of the Peace or Commissioner for Declarations)
Attachments*
Drop files here or

Accepted file types: jpg, tiff, png, pdf, Max. file size: 50 MB.
Please upload a certified copy of the applicant's current licence, permit or authority that authorises the applicant as a bookmaker or to conduct a wagering business (certified by a lawyer, Justice of the Peace or Commissioner for Declarations)
Attachments*
Drop files here or

Accepted file types: jpg, tiff, png, pdf, Max. file size: 50 MB.
Please upload a certified copy of the applicant's current licence, permit or authority that authorises the applicant as a bookmaker or to conduct a wagering business (certified by a lawyer, Justice of the Peace or Commissioner for Declarations)
Nature of Wagering Activity*
- Licensed Wagering Operator other than a Betting Exchange
- Betting Exchange

Application for authority to use Queensland race information

Application for authority period : 1 JULY 2021 – 30 JUNE 2023

Step 1 of 4

Is this your first time applying for authority to use Queensland race information?

Have you previously or do you currently hold an authority to use Queensland race information in your name, in the name of another entity, or otherwise in connection with your bookmakers licence or other authority?

APPLICATION FEE

What Best Describes You?

Please Select:

Applicant Details

Details of wagering licence, permit or authority held by the Applicant

Multiple Licences if entered

Are you licensed in an overseas country?

Expected wagering turnover

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