Forms to download
All forms are available in hard copy on request, from the relevant business group. See our contact details.
The majority of documents are available for download as pdf files. You need Adobe Acrobat Reader to view these documents, which can be downloaded for free from the Adobe site.
Class 4 Gambling: Cashless Gaming Machine Analysis
Description: As for Gaming Machine Analysis, where gaming machines are connected to a "cashless" system.
File Format: Adobe Acrobat
File Size: 111k
Class 4 Gambling: Category A Renewals Gaming Machine Account Summary (GC7)
Description: This form is used by single-venue clubs to renew their Class 4 Gambling Licences. (April 2017)
File Format: Adobe Acrobat
File Size: 540k
Class 4 Gambling: Category A Renewals Gaming Machine Account Summary (GC7) Guidance Notes
Description: Guidance notes for GC7 form (above).
File Format: Adobe Acrobat
File Size: 600k
Class 4 Gambling: Cessation Guidelines
Description: Cessation of a Class 4 Gambling Operator's Licence (March 2015)
File Format: Adobe Acrobat
File Size: 174k
Class 4 Gambling: Cessation Pack
Description: Cessation of Class 4 Gambling Operator's Licence (April 2017)
File Format: Adobe Acrobat
File Size: 507k
Class 4 Gambling: Class 4 Operator's Licence Key Person Amendments/Notifications (GC2)
Description: Amendment to Licence, or notification under section 54 of the Gambling Act 2003, related to Key Persons. Use this form if you want to: add a key person;remove a key person;change the designation of an existing key person; notify changes in circumstances as specified in section 54 of the Act.
If adding or changing the designation of a key person, that person must complete the 'Class 3 & 4 Key Person Personal Information' form.
We’re making changes to some of the requirements relating to GC5, GC4 and GC2 forms to capture any potential conflicts of interest which may lead to fraudulent behaviour. Please make sure you are using the most up to date form to avoid delays processing your applications.(April 2022)
File Format: Adobe Acrobat
File Size: 490k
Class 4 Gambling: Class 4 Operator's Licence Non-Key Person Amendments/Notifications (GC2A)
Description: Amendment to Licence, or notification under section 54 of the Gambling Act 2003, not related to Key Persons. Use this form if you want to: change your authorised purpose(s); change your problem gambling policies; change your method, system or policies for distribution of net proceeds; change your governing document; apply to accumulate funds; make any other change that may affect your ability to comply with the Act or your Class 4 Operator's Licence; provide details of disposal of gaming machines from society storage (no fee). (April 2017)
File Format: Adobe Acrobat
File Size: 616k
Class 4 Gambling: Class 4 Venue Licence Amendments & Non-Key Person Notifications (GC4A)
Description: Amendment to Licence, or notification under section 71 of the Gambling Act 2003, not related to Key Persons. (updated June 2023)
File Format: Adobe Acrobat
File Size: 1191k
Class 4 Gambling: Class 4 Venue Licence Key Person Notifications (GC4)
Description: Notification under section 71 of the Gambling Act 2003, related to Key Persons. (April 2022)
File Format: Adobe Acrobat
File Size: 570k
Class 4 Gambling: Daily Jackpot Cancelled Credit Report
Description: A system-specific report for recording manual payments (“hand pays") generated by "non downloadable" jackpot systems (i.e. those that do not download win information to individual gaming machines).
File Format: Adobe Acrobat
File Size: 122k
Class 4 Gambling: Daily Jackpot Turnover Report
Description: A venue-specific report to be completed for "downloadable" jackpot systems to compare gaming machine hard turnover meters with jackpot controller turnover data.
File Format: Adobe Acrobat
File Size: 103k
Class 4 Gambling: Gambling Equipment Fault/Player Dispute Report
Description: A combined checklist and record of essential details in relation to gambling equipment faults or malfunctions; and / or player disputes in connection with gambling equipment operation.
File Format: Adobe Acrobat
File Size: 136k
Class 4 Gambling: Gaming Machine Analysis Report
Description: A machine-specific report to record and analyse gaming machine meters, meter differences, machine operation and associated cash transactions.
File Format: Adobe Acrobat
File Size: 113k
Class 4 Gambling: Gaming Machine Analysis Spreadsheet
Description: In response to a number of requests, we have produced the Gaming Machine Analysis Report in a simple Microsoft Excel spreadsheet that allows figures and other data to be input and automatically works out meter differences. It is essentially the same as the PDF version but has some minor additional functionality (e.g. highlighting the difference between actual and calculated hopper movement). You are welcome to download and use it instead of the PDF version if it suits your gaming machine operation. If you have any questions or experience any difficulties using it, please contact Senior Inspector Technical David Chatwin - direct dial (03) 353 8308 or email david.chatwin@dia.govt.nz.
File Format: Adobe Acrobat
File Size: 436k
Class 4 Gambling: Record Keeping for (Monthly) Gaming Operations
Description: Clubs can update this spreadsheet with data from the start of the financial year. You can add more Authorised Purposes (AP) that correspond to the club's gambling licence. Total boxes and AP percentages will be calculated automatically if the formula stays the same. If you have any questions about using the spreadsheet, please contact Lance Daly, Team Leader Licensing Compliance: phone 09 362 7921 or email lance.daly@dia.govt.nz
File Format: Adobe Acrobat
File Size: 21k
Class 4 Gambling: Standard Financial Statements - Forecast Accounts Signoff (Clubs)
Description: Template to help clubs that operate Class 4 gaming machines to prepare forecast accounts sign-off necessary to complete their application to renew Class 4 operator's licence and venue licence(s).
File Format: Adobe Acrobat
File Size: 99k
Class 4 Gambling: Unpaid Prize Report
Description: A report to record instances where, for any reason, a prize awarded by gambling equipment is not paid out.
File Format: Adobe Acrobat
File Size: 100k
Class 4 Gambling: Weekly Banking Reconciliation Report
Description: A venue-specific report to record details of individual bank deposits relating to the weekly GMP amount.
File Format: Adobe Acrobat
File Size: 93k
Class 4 Gambling: Weekly Gaming Machine Profits Report
Description: A venue-specific report to be used only in certain circumstances after EMS connection (i.e. in the absence of the EMS-generated "Weekly Venue Activity" report) to record weekly turnover, wins and jackpot wins meter differences and to calculate GMP for weekly banking.
File Format: Adobe Acrobat
File Size: 115k
Class 4 Gaming Machine Account Summary (Guidance Notes for GC6)
Description: April 2017
File Format: Adobe Acrobat
File Size: 253k
Exclusion Order (Problem Gamblers) Form
Description: Use this form to exclude patrons from your venue (under sections 309 and 310 of the Gambling Act 2003).
File Format: Adobe Acrobat
File Size: 57k
Financial Forecast Sign-Off Guidance for Societies and Clubs
Description: The Department requires an Independent Chartered Accountant with a Certificate in Public Practice to verify the financial information provided in the Gaming Machine Account Summary form (GC6) by performing specific procedures. This is known as an Agreed-upon procedures engagement.
This engagement needs to be carried in accordance with APS -1 Statement of Agreed-upon procedures Engagement Standards and Guidelines of the New Zealand Institute of Chartered Accountants.
File Format: Adobe Acrobat
File Size: 399k
GamblingLicensing_Casino_COA-May-2024
Description: May 2024
File Format: Adobe Acrobat
File Size: 753k
GC6 Category B Renewals, Gaming Machine Account Summary (Post Venue Payments Transition Year)
Description: Updated January 2018
File Format: Adobe Acrobat
File Size: 550k
Adult application for a Grant of New Zealand Citizenship
Description: Adult application form required when applying for New Zealand citizenship by grant.
File Format: Adobe Acrobat
File Size: 312k
Child application for a Grant of New Zealand Citizenship (under 16 years)
Description: Child application form required when applying for New Zealand citizenship by grant (under 16 years).
File Format: Adobe Acrobat
File Size: 299k
Application Guide for a Grant of New Zealand Citizenship - Samoan
Description: Application guide when applying for a New Zealand citizenship by grant for Samoan Citizens.
File Format: Adobe Acrobat
File Size: 252k
Application for a Grant of New Zealand Citizenship for Samoan Citizens
Description: Application form required when applying for New Zealand citizenship by grant by Samoan Citizens.
File Format: Adobe Acrobat
File Size: 252k
Application for Confirmation of NZ Citizenship by Grant
Description: Application form for confirmation of New Zealand citizenship by grant.
File Format: Adobe Acrobat
File Size: 256k
Confirmation of New Zealand Citizenship by Descent
Description: Confirmation of New Zealand Citizenship by Descent
File Format: Adobe Acrobat
File Size: 186k
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