Personal Licence - Reference Declaration v1.0
Employer’s declaration
Please read and sign the declaration below to confirm that references for this applicant are being, or have
been, taken up.
I confirm that I have no information or reason why the Gambling Commission should not grant a licence and, if the
applicant has been working for me for less than two years, that references have been taken up.
Where the applicant has joined your company recently and you do not yet have references:
I confirm that I am in the process of taking up references and will provide confirmation that references have been
taken up and that I have no information or reason why the Gambling Commission should not grant a licence.
Reference Declaration
Signed Date
D D M M Y Y Y Y
Signed Date
D D M M Y Y Y Y
First name(s)
Last name
Position in organisation
On behalf of: employer/organisation
Email address
@
Address line 2
Town/city
Country
Address line 1
Postcode/zip code
+
Work number (country code, area code & number)
Operating Licence number
- - - -
click to sign
signature
click to edit
click to sign
signature
click to edit
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