Application For Lottery Licensing Eligibility

Please note that an incomplete application will delay licensing eligibility.

Name of Organization

Please select the Ward

Beardmore

Longlac

Geraldton

Nakina

Official Address of Organization

Mailing Address for Organization

Does the Organization have a place of business in Ontario? If so, where?

How long has the Organization been in operation?

Which of the four classifications of charitable objects does the primary purposes of the Organization match?

the relief of poverty

the advancement of religion

the advancement of education

any other charitable purpose beneficial to the community not falling under the 3 above (please list below)

What are your Charitable Programs and Services?

Is the Organization established to provide charitable services in Ontario and use of proceeds for objects or purposes which benefit Ontario residents?

Yes

No

Is the charitable benefit to be achieved by the application denied to any segment of the community?

Yes

No

Does a large portion or percentage of the community, as a whole, benefit by the fundraising of the applicant?

Yes

No

Is the applicant properly organized such that it is separate from any other organization? (e.g. legally, financially, organizationally)

Yes

No

Has the applicant been in operation for at least one (1) year and have a proven charitable mandate?

Yes

No

Does your organization have by-laws and/or a constitution? (If yes, please attached a copy to this application)

Yes

No

Is the Organization registered with Revenue Canada as a Charitable Organization?

Yes

No

Is the Organization incorporated as a non-profit organization in the Province of Ontario?

Yes

No

Is the Organization presently licensed by any other Municipality in Ontario?

Yes

No

Please describe your organizations aims and objectives.

We, the undersigned, declare that all information provided in and with the application is factual and correct.

Name of Principle Officer

Contact Information: Phone Number and/or Email

Signature of Principle Officer

Clear

Date

Name of Principle Officer

Contact Information: Phone number and/or Email

Signature of Principle Officer

Clear

Date

BANKING INFORMATION

For the purposes of lottery licensing, all organizations must have a lottery trust account.

Banking Information is Required For Eligibility.

Please complete the following:

Name of Bank and address

Trust Account Number

Date Account Opened

The designated member of the organization who will be responsible for keeping and maintaining all financial transactions pertaining to the licensed lottery activities:

Name of Designated Member

Business Address and Mailing Address

Contact Information: Cell Phone, Business Phone, Home Phone, email address

Personal information contained in this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Questions about this collection should be directed to the Office of the Clerk where the request is made.

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Application For Lottery Licensing Eligibility

Please note that an incomplete application will delay licensing eligibility.

BANKING INFORMATION

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