Required fields are marked with asterisks (*)

Lottery Licensing Eligibility

You can submit this form to establish your organization as eligible to operate a lottery.

The Licensing Officer will review all relevant documentation submitted to determine eligibility for lottery licences in accordance with the policies issued by the Registrar of Alcohol & Gaming Commission of Ontario. For more information about lottery licensing eligibility, reference the AGCO Lottery Licensing Policy Manual.

Full name of organization

Phone

Address

Town/City

Postal code

What type of organization?

Charity

Non-Profit with charitable objects

None of the above

Which of the four classifications of charitable objects do the primary purposes of the organization relate to?

Advancement of education

Advancement of religion

Relief of poverty

Any other charitable purpose beneficial to the community not falling under any of the above categories:

Mandatory Pre-Requisites

These pre-requisites are mandatory to be considered eligible for a lottery licence

Has your organization been in existence for at least one (1) year?

Yes

Does your organization have a place of business in Ontario and can demonstrate that it is established to provide charitable services in Ontario and use proceeds for objects or purposes which benefit Ontario residents?

Yes

To determine eligible use of proceeds, you must set out in detail the purposed uses of proceeds. The organization's use of proceeds must be for charitable programs & the programs must benefit Ontario residents.

Has your organization held a lottery licence from Haldimand County within the past 3 years?

Yes

Indicate which documents you are submitting with this eligibility form.

Incorporation Papers (Letters Patent)

Constitution and Bylaws

Current operating budget

Financial statements for the preceding year

Current listing of Board of Directors

Notification of Charitable Registration (Canada Customs and Revenue Agency) (if applicable)

The most recent Registered Charity Information Return & Public Information Return, as submitted to Canada Customs and Revenue Agency (if applicable)

Detailed outline of all programs/services provided in the previous year and specific costs incurred in delivery

Any other information that will assist in determining the charitable nature of the objects and purposes. (This could include the annual report, charitable number for income tax purposes, brochures, newspaper articles etc.)

Upload your organization's incorporation papers (letters patent)

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Please agree to the statement below.

I understand it is my responsibility to ensure all required documentation is provided to the Licencing Officer in order for the licencing eligibility to be completed.

Name of signing officer

Title of the signing officer

Signature of the signing officer

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