Betting Account Declaration

New Zealand Thoroughbred Racing

This is an ELECTRONIC APPLICATION. Printing the form and filling it out by hand will result in your application being ineligible.

Name

First NameLast Name

Email

example@example.com

I declare that I,

do not have any betting accounts with any betting operators (including, without limitation, bookmakers, totalisators or betting exchanges), whether located in or outside New Zealand and whether in my name or under any other name, nor do I bet or have bets placed on my behalf through any betting accounts with any such betting operators held in any other person’s name.do have betting accounts with betting operators and have set out below all of my betting accounts (whether in my name or under any other name) and further declare that:

I do not have any betting accounts with any betting operators (including, without limitation, bookmakers, totalisators or betting exchanges) whether located in or outside New Zealand and or whether in my name or under any other name, other than the betting accounts set out below, and agree that I will, on the written request of either NZTR or the Racing Integrity Board, provide access to, and such other information as may be requested relating to, my betting accounts (whether in my name or under another name) and any bets placed through those accounts.
I only bet through the betting accounts set out below and do not bet through any other betting accounts, whether held in my name or the names of any other persons.
To the best of my information, knowledge and belief, no one has placed a bet on my behalf in the past year or since I last made a Betting Account Declaration.

Betting Account

Betting OperatorAccount NameAccount Number

Betting Account

Betting OperatorAccount NameAccount Number

Betting Account

Betting OperatorAccount NameAccount Number

Signature

CONTACT US

If you have any queries relating to this application, please contact NZTR Licensing at:

tel: +64 4 576 6240

email: office@nztr.co.nz