Forms

Please use the links below to access forms related to land-based Poker Rooms, Electronic Gaming Devices, and Raffles that are licensed by the Kahnawà:ke Gaming Commission.

*NOTE: Our office hours are:  Monday to Friday 8:30 AM to 4:00 PM – CLOSED FOR LUNCH FROM 12:00 PM TO 1:00 PM.

Electronic Gaming Devices

The forms accessible from this page are required for applications and renewals of Electronic Gaming Devices Licences and for other matters related to Electronic Gaming Devices that are licensed and regulated by the Commission.

Full Disclosure Assurance Form
Release and Waiver of Liability Form
Criminal Record Information – Consent Form and Privacy Waiver
Schedule A – Application for Operator’s License
Schedule B – Business Entity Information Form
Schedule C – Personal Information Form
Schedule D – Application for Key Person Permit
Schedule E – Request to Temporarily Close
Schedule F – Material Change Report
Schedule G – Renewal Application
Schedule H – Comprehensive Self-Exclusion Request (English)
Schedule H – Comprehensive Self-Exclusion Request (French)
Schedule I – Request to Revoke (English)
Schedule I – Request to Revoke (French

Poker Rooms

The forms accessible from this page are required for applications and renewals of Poker Room Licences, Dealer Permits and Key Person Permits – and for other matters related to Poker Rooms that are licensed and regulated by the Commission.

Full Disclosure Assurance Form
Criminal Record Information – Consent Form and Privacy Waiver
Applicable Fees
Schedule A – Approved Games
Schedule B – Repealed 25, Onerahtókha/April, 2012
Schedule C – Application for Poker Room License
Schedule D – Business Entity Information Form
Schedule E – Personal Information Form
Schedule F – Key Person Permit Application
Schedule G – Dealer Permit Application
Schedule H – Renewal Application
Schedule I – Written Request for Special Events License
Schedule J – Application to be Appointed an Approved Supplier – Repealed 26 Enníska/February, 2014
Schedule K – Comprehensive Self-Exclusion Request
Schedule K – Comprehensive Self-Exclusion Request (French)
Schedule L – Request to Revoke
Schedule L – Request to Revoke (French)
Schedule M – Request to Temporarily Close
Schedule N – Material Change Report
Schedule O – Request to be Declared Dormant

Raffle Forms

The forms accessible from this page are required for an application for a Raffle Authorization – and for other matters related to any Raffle that is licensed and regulated by the Commission.

Schedule A – Application for Raffle Authorization
Schedule B – Compliance Agreement
Regulations Concerning Raffles
Frequently Asked Questions Raffles