Registration

             Part 2 Personal Disclosure form - fillable PDF

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM

 a. You must make accurate statements and include all material facts. Any misrepresentation, or the failure to provide requested information, will result in a delay of your application.

 b. Read each question carefully prior to answering. Answer every question completely. Do not leave blank spaces. If a question does not apply to you, indicate “Does Not Apply” in response to that question. If there is nothing to disclose in response to a particular question, indicate “None” in response to that question. Failure to provide a response to every question will result in a delay in your application.

 c. If the space available is insufficient to respond to a question, you are to supply the required information on an attachment page and clearly identify which question you are answering. The blank page on page 64 may be used to provide this additional information.

 d. Once your application is accepted, it becomes the property of the Manitoba Gaming Control Commission.

BE SURE TO:

 e. Attach a recent (within the past six months) colour photograph of yourself in the space provided on page 67. If you have an electronic or digital version of the photo, you may attach it to the e-mail when you send in this completed document or mail it with the documents in step f.

 f. Print off pages 65 and 66 and fill them in by hand. These 2 pages are then to be faxed to (204-954-9451). The original copies of page 65 and 66 must then be mailed to the MGCC Registration Department at the following address: 800-215 Garry Street Winnipeg, Manitoba, Canada R3C 3P3

Click here to open the Personal Disclosure Form (PDF format). It is recommended that you save this form to disk right away and then several times while you are completing it. The form contains 68 pages and will take a reasonable amount of time to complete.

It is also recommended that you have the latest version of the Adobe Acrobat Reader on your system to view and use this report. Click here to get the latest version.

Once the Personal Disclosure form is completed email the document to: disclosure@mgcc.mb.ca

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