Application For Horse Racing Licence And Registration

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Application for Horse Racing
Licence and Registration
Gaming Policy and Enforcement Branch – Racing Division
Hastings Racecourse
Fraser Downs Raceway
Mail/Courier: #408-4603 Kingsway, Burnaby, BC V5H 4M4
Telephone: (604) 660-9090
Telephone: (604) 576-3727
Telephone: (604) 660-7407
Fax: (604) 660-7414
Fax: (604) 775-1752
Fax: (604) 576-7910
Web:
BEFORE YOU START
Use this form to apply for a licence to work in the horse racing industry in British Columbia.
Applications must include a non-refundable application fee of $30 (cash, money order, or cheque payable to the “Minister of Finance”).
Applications must include copies of two pieces of personal identification, including one piece of picture identification.
Applications must be completed in full; signature is required in Section 5.
SECTION 1 – APPLICANT INFORMATION
PLEASE PRINT CLEARLY
Surname: (current legal surname)
First name: (legal first name)
Middle name(s): (legal middle names)
Licence type:
Racetrack name:
Medical number: (if you are a rider / driver)
Advised: (signature of judge / steward)
X
Previous licence type:
Previous racetrack name:
Year of previous licence:
Address: (current address) Unit and Street
City
Province
Postal Code
Home phone number: (XXX) XXX-XXXX
Work phone number: (XXX) XXX-XXXX
Email or Text (SMS):
Date of birth: (YYYY-MM-DD)
Gender:
City of birth:
Country of birth:
M
F
Are you a Canadian citizen:
Immigration status: (i.e. visitor, working visa, landed immigrant, etc.)
If NO, you must supply landed immigrant or
Yes
No
work permit documents.
Spouse’s full name: (surname, first name, middle names)
Social Insurance Number:
Married:
Yes
No
Former surnames, legal name changes, or any nicknames: (attach a separate sheet if more space is required)
Surname:
First name:
Middle name:
Date: (YYYY-MM-DD)
Places of residence for the last five years: (city and province/state only – attach a separate sheet if more space is required)
City:
Province/State:
City:
Province/State:
GAMING POLICY AND ENFORCEMENT BRANCH USE ONLY
Expiry date:
New/renewal:
Occupational season:
Licence #:
Location of issue:
Receipt #:
Date:
(T)BRED or (S)BRED:
GBC ID #:
Application #:
Keep your personal information safe. Your completed electronic or paper copy of this form
June 15, 2016
should be stored in a safe and secure place, or destroyed in a secure manner.
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