Registration of a Greyhound Syndicate Application

Registration of a Greyhound Syndicate Application

Notes to application

1. This application must be lodged with your Territory Business Centre.
2. All details are to be completed in block letters.
3. If the space provided is insufficient, please present relevant information on a separate sheet.
4. The following are documents that must be lodged with the application:
5. the prescribed fee(please refer to the relevant schedule of fees on the website)
6. two passport sized photographs for each syndicate member
7. copy of photo ID (current drivers licence or passport)

Application details
For year ending February 20
We hereby make application for registration of the below named Syndicate and in consideration of the Commission granting such application, we hereby agree that the Commission (in its absolute discretion and without being in any way bound to do so) at any time and from time to time may treat
(insert manager name)
as Manager for the purposes of the rules and decisions of the Commission as if such Manager were the sole owner and/or as the sole representative of the Syndicate in relation to any greyhound in respect of which the Syndicate may be the nominator or may have a propriety interest whether as owner, lessee or otherwise or have or exercise as right of control or disposition and notwithstanding any change or changes which may occur in the constitution of the Syndicate.
Syndicate name
1st Choice / 2nd Choice
3rd Choice / 4th Choice
5th Choice / 6th Choice
7th Choice / 8th Choice
Syndicate 1 – Manager details
Full name
Residential Address
Date of birth / Telephone
Email address
Syndicate 2
Full name
Residential Address
Date of birth / Telephone
Syndicate 3
Full name
Residential Address
Date of birth / Telephone
Syndicate 4
Full name
Residential Address
Date of birth / Telephone
Syndicate 5
Full name
Residential Address
Date of birth / Telephone
Syndicate 6
Full name
Residential Address
Date of birth / Telephone
Syndicate 7
Full name
Residential Address
Date of birth / Telephone
Syndicate 8
Full name
Residential Address
Date of birth / Telephone
I hereby confirm my nomination as Manager:
Signature / Date
Questionnaire – to be completed by all applicants
Syndicate 1 - Manager
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Syndicate 2
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Syndicate 3
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Syndicate 4
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Syndicate 5
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Syndicate 6
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Syndicate 7
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Syndicate 8
Have you ever previously been registered as an owner, trainer, attendant, spokesman, bookmaker or bookmaker’s key employee? If yes, state in which capacity you were registered and by whom below: / Yes No
Are any of the named greyhounds held on lease by you? If yes, state name(s) of greyhounds and owner(s) below: / Yes No
Have you ever been disqualified, suspended, warned off, fined or listed as a defaulter by any racing authority? If yes, provide details below: / Yes No
Have you ever been found guilty of an offence punishable by fine or imprisonment? If yes, provide details below: / Yes No
I certify that the information given above is true and accurate.
Signature / Date
Owner’s registration certificate
We hereby make application for an Owner’s Registration Certificate. As conditions of the granting of this Application, we hereby agree:
a)That no persons other than persons registered with the Commission or other approved Registration Authority shall at any time during the currency of this Licence assist in the training or handling of greyhounds in our care.
b)To notify the Commission on the prescribed form of the names of all greyhounds housed in our kennels for a period exceeding 72 hours and forthwith of all greyhounds removed from our kennels.
c)To observe the following conditions when exercising greyhounds in a public street, park or place;

1. such greyhounds shall be properly muzzled and on a leash
2. one person shall not exercise more than four greyhounds at any one time
3. no greyhound shall be exercised in any public park without the consent of the authority in control of that park.

d)To be bound by and to comply with all such rules and statutory provisions in respect to Greyhound Racing and the registration of greyhounds as shall for the time being and from time to time be in force and be made by the said Commission and all decisions and directions that shall from time to time be made thereunder by the Commission or by any other authority or person authorised under such rules to make same.
The only kennels housing the greyhound(s) owned by this Syndicate are situated at
Address
and we agree to notify the Commission forthwith of any change (temporary or otherwise) of any change in the address of our kennels.
At the date of this Application the undermentioned greyhound(s), for which Owner’s Racing Registration Certificates are required, are registered in our names as Members of this Syndicate
Name of greyhound(s) / Name and address of trainer(s)
If insufficient space, attach separate list.
The undermentioned are greyhounds for which Owner’s Racing Certificates are not required but are registered in our names as Members of this Syndicate (i.e. non-racing dogs)
Name of greyhound(s) / Address where kennelled
If insufficient space, attach separate list.
Signatures of applicants
Manager / Syndicate 2
Syndicate 3 / Syndicate 4
Syndicate 5 / Syndicate 6
Syndicate 7 / Syndicate 8
Office use only
Date received / Cash receipt number
Notice in accordance with the Information Act(Information Privacy Principle 1)
Licensing NT is seeking information from you for the purposes of your application.
Information Privacy Principle 1 (IPP 1) requires that a public sector organisation must not collect personal information unless the information is necessary for one or more of its functions or activities. If personal information about an individual is collected from the individual, the organisation must take reasonable steps to ensure that the individual is aware of certain matters. For the purposes of IPP 1, the following advice is provided.

1. You are able to access your personal information that you have provided by making a written request to the Director-General of Licensing.
2. The information is required pursuant to the Racing and Betting Act. The Act requires that certain matters must be considered when deciding whether or not to approve an application.

1. The information will be kept confidential except as follows:
2. Information may be sought from Police, government agencies, interstate licensing authorities, or referees or other persons nominated by you. Information may be released to those sources to the extent necessary to verify information about you and your application.
3. If a hearing is involved, information will be released to the parties, Commission or the Court, as required by the Act.
4. Registers of licences and permits will be maintained and may be made available to the public on request.

1. You do not have to provide information if you do not wish to do so. However, an application may not be approved if there is insufficient information to properly determine the matter in accordance with the Act.

Lodgement options
Applications can be lodged at a Territory Business Centre with the prescribed fee at:
Darwin
Building 3,Darwin Corporate Park,
631 Stuart Highway,
Berrimah
GPO Box 9800
Darwin NT 0801
t: (08) 8982 1700
f: (08) 8982 1725
Toll free: 1800 193 111
e: / Katherine
Shop 1, Randazzo Building
18 Katherine Terrace
Katherine
PO Box 9800
Katherine NT 0851
t: (08) 8973 8180
f: (08) 8973 8188
e:
Tennant Creek
Shop 2, Barkley House
Cnr Davidson and Paterson Streets
Tennant Creek
PO Box 9800
Tennant Creek NT 0861
t: (08) 8962 4411
f: (08) 8982 1725
e: / Alice Springs
Ground Floor, The Green Well Building
50 Bath Street
Alice Springs
PO Box 9800
Alice Springs NT 0871
t: (08) 8951 8524
f: (08) 8951 8533
e:
DEPARTMENT OF THE ATTORNEY-GENERAL AND JUSTICE
25 October 2018 / Page 1 of 14