Sch 5Application to publish and use Victorian race fields

Schedule 5—Application to publish and use Victorian race fields Regulation 56 Application to Publish AND Use Victorian Race Fields I apply for approval to publish and use the following race fields information: 🞎 Victorian horse racing race fields 🞎 Victorian harness racing race fields 🞎 Victorian greyhound racing race fields Please tick DETAILS OF APPLICANT Name of Applicant: Address of Applicant: Applicant's contact details: State, Territory or Country where Applicant is licensed to operate: Trading names used by Applicant: Applicant's ACN or ABN: ADDITIONAL INFORMATION [*Insert any additional information required by the appropriate controlling body under section 4.2.3B(2)(c) of the* ***Gambling Regulation Act 2003***.] CERTIFICATION I certify that I am authorised to make the application on behalf of and that the information provided is true and correct. Signature of authorised representative: Name of authorised representative: Date: Sch. 6 amended by S.R. Nos 111/2016 reg. 9, 121/2023 reg. 18.