#CasinoSecrets

Investigating the Offshore Online Gambling Industry

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The inclusion of a person, company, domain, or other entity in the CasinoSecrets database does not imply illegal or improper conduct. The data was extracted directly from relevant gambling authorities and official registers on the basis of a significant public interest and reflects information available up to August 2026.

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Ansom B.V.

Gaming OperatorRegistered April 11, 2025
2
Applications
0
Domains
9
Related Entities
0
Locations

CGA/2025/2528/1329

On Hold
Submitted: July 17, 2025End Date: July 29, 2026

Customer

Contact
Maya Baroud
Email
ansomchambers@gmail.com
Company
Ansom B.V.

Review Timeline

Verification
SCSarah Cathalina-Labbe (CGA user 10)
Verification
AAAnton Axiaq (AAX)
Verification
MMMarilisa Mathew (CGA User 1)

Compliance Checklists

Supplier License ApplicationCritical24 items
Correct Application VersionIncomplete FormMinorDue Jul 30, 2026

The application must be the latest version available on the CGA website and must contain the same number of pages. Inspect all pages to ensure that there are no blank pages and that the application is the most updated version. Check the form.

The Supplier License application form is not the official form supplied by CGA. Kindly complete the correct form and submit it.

Application is Filled DigitallyIncomplete FormMinorDue Jul 30, 2026

Check the form and verify there are no ink marks or handwritten notes. Check the form.

The Supplier License application form contains handwritten information or ink marks. Kindly resubmit the form without handwritten information or ink marks.

PAGE 1: APPLICATION NUMBERQuestionMinorDue Jul 30, 2026

Must be filled in and match the application number in the portal. Check the form and verify the application number matches the one in the portal.

The application number of the Supplier License application form is missing or incorrect. Kindly resubmit the form with the correct application number.

PAGE 1: APPLICATION DATEQuestionCriticalDue Aug 26, 2026

The application date must be filled in and within six months of today’s date. Check the form.

The application date is more than six months old. Kindly resubmit the form with the correct application date.

PAGE 1: QUESTION 1QuestionMinorDue Jul 30, 2026

The Brand Name field must be filled in. Check the form.

The brand name in question 1 is missing. Kindly complete question 1 and resubmit the form.

PAGE 1: QUESTION 2QuestionMinorDue Jul 30, 2026

The Company Name field must be filled in as registered with the Chamber of Commerce of Curaçao. Check if the company name matches the registered name on te excerpt of the Chamber of Commerce of Curaçao.

The company name is missing or does not match that registered with the Curaçao Chamber of Commerce. Kindly complete question 2 and resubmit the form.

PAGE 1: QUESTION 3QuestionMinorDue Jul 30, 2026

At least one Business Model must be selected. Check if at least one Business Model is selected.

The response to question 3 is missing. Kindly select at least one Business Model and resubmit the form.

PAGE 1: QUESTION 4QuestionMinorDue Jul 30, 2026

At least one Gaming Type must be selected. Check the form.

The response to question 4 is missing. Kindly select at least one Gaming Type and resubmit the form.

PAGE 1: QUESTION 4QuestionMinorDue Jul 30, 2026

If 4.1, 4.3, 4.6 or 4.9 is selected then the corresponding field must filled in. Check the form.

PAGE 2: QUESTIONS 5 AND 6QuestionMinorDue Jul 30, 2026

Question 5 or 6 must have at least one entry between them. Check the form.

The currency details in questions 5 and/or question 6 are missing. Kindly fill in the currency details and resubmit the form.

PAGE 2: QUESTION 7QuestionMinorDue Jul 30, 2026

Must be filled out. Check the form.

The response to question 7 is missing. Kindly list the countries where the servers are located (using a comma separated list) and resubmit the form.

PAGE 2: QUESTION 9QuestionMinorDue Jul 30, 2026

If "Yes" is selected, then answer 9.1 must be filled in. Check the form.

Question 9 and/or 9.1. is not completed. Kindly complete question 9 and/or question 9.1 and resubmit the form.

PAGE 2: QUESTION 10QuestionMinorDue Jul 30, 2026

At least one option must be selected. Check the form.

The response to question 10 is missing. Kindly complete question 10 and resubmit the form.

PAGE 2: QUESTION 11QuestionMinorDue Jul 30, 2026

If "Yes" is selected, then 11.1 must be filled in. Check the form.

The response to question 11.1 is missing. Kindly complete the question and resubmit the form.

PAGE 2: QUESTION 12QuestionMinorDue Jul 30, 2026

If 'Yes" is selected then 12.2. must be filled in. Check the form.

The response to question 12.2 is missing. Kindly complete the question and resubmit the form.

PAGE 3: QUESTION 13QuestionMinorDue Jul 30, 2026

The full name of the contact person must be filled in. Check the form.

The first and/or last name of the contact person in question 13 is missing. Kindly fill it in and resubmit the form.

PAGE 3: QUESTION 13QuestionCriticalDue Aug 26, 2026

The name of the contact person must be the same as the portal administrator. Check the form.

The contact person must be the portal administrator.

PAGE 3: QUESTION 14QuestionCriticalDue Aug 26, 2026

Must be filled in. Check the form.

The information entered must be the information of the portal administrator.

PAGE 3: QUESTION 15QuestionCriticalDue Aug 26, 2026

The contact person's passport number is required. Check the form.

The information entered must be the information of the portal administrator.

PAGE 3: QUESTION 16QuestionCriticalDue Aug 26, 2026

The country of issue for the contact person's passport is required. Check the form.

The information entered must be the information of the portal administrator.

PAGE 3: QUESTION 17QuestionCriticalDue Aug 26, 2026

The contact person's contact address is required in full: Street name, building number City/town State/county/province Country, zip code/postal code Check the form.

The information entered must be the information of the portal administrator.

PAGE 3: QUESTION 18QuestionMinorDue Jul 30, 2026

The email address is required. Check the form.

The email address is missing in question 18. Kindly fill in question 18 and resubmit the form.

PAGE 3: QUESTION 18QuestionMinorDue Aug 26, 2026

The email address must be the same as that of the portal administrator. Check the form.

The email address must match the email address of the portal administrator as registered in the portal.

PAGE 4: DECLARATION AND DATA PRIVACYQuestionCriticalDue Aug 26, 2026

The name and surname of the managing director must be filled in and the form must be digitally signed. Check the form.

The name of the managing director, Jonathan Heymans, must appear at the top of the page and the form must be digitally signed by him.

Business and Corporate Information FormCritical33 items
Missing PagesIncomplete FormCriticalDue Jul 30, 2026

Check if all pages are in the submitted form

The form has missing pages. Please refill the complete form and resubmit.

PAGE 1: APPLICATION NUMBERQuestionCriticalDue Jul 30, 2026

Make sure that this is filled in and the same as that shown on the portal.

The application number of the Business and corporate application form is missing or has an incorrect application number. Kindly resubmit the form with the correct application number.

PAGE 1: APPLICATION DATEQuestionCriticalDue Aug 26, 2026

The application date must be filled and within six month's of today's date.

The application date is more than six months old. Kindly resubmit the form with the correct application date.

PAGE 1: QUESTION 1QuestionCriticalDue Jul 30, 2026

The Brand Name field must be filled.

The brand name in Question 1 is missing. Kindly fill in Question 1 and resubmit the form.

PAGE 1: QUESTION 2QuestionCriticalDue Jul 30, 2026

The Company Registered Name field must be filled.

The Business and corporate information form is missing the response to Question 2. Kindly fill Question 2 and resubmit the form.

PAGE 1: QUESTION 3QuestionCriticalDue Jul 30, 2026

The Company Registered Number must filled.

The Company Registered Number is missing or incorrect. Kindly fill Question 3 and resubmit the form.

PAGE 1: QUESTION 4QuestionCriticalDue Jul 30, 2026

Check if the company Tax ID is correct, based on the declaration of Good Standing. The Company Tax ID Number must be filled.

The Company Tax ID Number is incorrect/ missing. Kindly fill Question 4 and resubmit the form.

PAGE 1: QUESTION 5QuestionCriticalDue Jul 30, 2026

The Company Date of Incorporation must be filled. Date must be DD-MMM-YYYY format

The date of incorporation is missing. Kindly fill Question 5 and resubmit the form.

PAGE 1: QUESTION 6QuestionCriticalDue Jul 30, 2026

The Company Corporate Address must be filled.

The Company corporate address is missing . Kindly fill Question 6 and resubmit the form.

PAGE 1: QUESTION 7QuestionCriticalDue Jul 30, 2026

One option must be selected.

A response is to question 7 is missing. Please select an option and resubmit the form.

PAGE 1: QUESTION 7QuestionCriticalDue Jul 30, 2026

If option 7.2 is selected, then 7.2.1 must be completed

A response is to Question 7.2.1. is missing. Please select an option and resubmit the form.

PAGE 1: QUESTION 7QuestionCriticalDue Jul 30, 2026

If option 7.3 is selected, then 7.3.1 must be completed.

A response is to Question 7.3.1. is missing. Please select an option and resubmit the form.

'PAGE 1: QUESTION 10QuestionCriticalDue Jul 30, 2026

If selected, we must verify the screenshot.

The screenshot of the goAML registration of the applicant is missing, kindly resubmit.

PAGE 2: QUESTION 9QuestionCriticalDue Jul 30, 2026

If question 9 is selected, then question 9.1 must be filled.

A response to question 9.1 is missing. Please fill in and resubmit the form.

PAGE 2: QUESTION 11QuestionCriticalDue Jul 30, 2026

One option must be selected.

Question 11 is not filled out. Please select an option in question 11 and resubmit the form.

PAGE 2: QUESTION 11QuestionCriticalDue Aug 26, 2026

If question 11.1 is selected then question 11.1.1. must be filled.

In question 11.1.1 both the <u>currency</u> and the amount must be indicated.

PAGE 2: QUESTION 11QuestionCriticalDue Jul 30, 2026

If question 11.2. is selected then questions 11.2.1. and 11.2.2. or 11.2.3. must be selected.

The response to question 11.2.1. and/or 11.2.2./11.2/3 is missing or incorrect.

PAGE 3: QUESTION 12QuestionCriticalDue Aug 26, 2026

Yes must be selected, if B2C as it must always have a compliance officer, therefore 12.1 must be filled.

If there are any other individuals holding c-suite level positions, they must be added in question 12.1.

PAGE 3: QUESTION 13QuestionCriticalDue Aug 26, 2026

Must be filled.

Question 13 was completed incorrectly. In the <i>"Name of Company" </i>field, please enter the name of the applicant entity. In the <i>"Holder"</i> field, please enter the name of the UBO.

PAGE 4: DECLARATION AND DATA PRIVACYQuestionCriticalDue Aug 26, 2026

The document must contain name and surname of the official representative and must be digitally signed and verified.

The name of the managing director, Jonathan Heymans, must appear at the top of the page and the form must be digitally signed by him.

Company StructureQuestionCriticalDue Aug 26, 2026

An updated company structure diagram showing direct and indrect equity and control percentages signed by a company director of the applicant company.

The company structure must be signed by the managing director Jonathan Heymans.

Number of Qualifying PersonsQuestionCriticalDue Jul 30, 2026

Determine how many UBO(s), Qualifying Interest Holder(s) and listed UBO(s). Calculate fee ((Total UBO(s) + Qualifying Interest Holder(s) + listed UBO(s) - one UBO EUR 150) Inform Finance to Issue an Invoice.

Inform Finance to Issue an Invoice.

1 UBO
[Sarah Cathalina-Labbe - 16-07-2026 19:20]
Share Ledger DocumentQuestionCriticalDue Aug 26, 2026

Check Share ledger Document of the applicant company including companies holding 10% or more shareholding in the applicant company.

Please submit a certified copy of the share ledger.

Share Ledger of Intermediate CompaniesQuestionCriticalDue Jul 30, 2026

Share ledger of intermediate company(ies) or holding company(ies) 10% or more shareholding in the applicant company.

The enclosed document, Share ledger of the company/holdings is not certified/ missing. Kindly resubmit.

Directors ListQuestionCriticalDue Aug 26, 2026

Check document, must be signed by the managing director unless it is an stamped excerpt from the Chamber of Commerce.

Please submit a certified copy of the directors list.

Directors list of Intermediate companiesQuestionCriticalDue Jul 30, 2026

Directors list for of intermediate company(ies) or holding company(ies) 10% or more shareholding in the applicant company.

The enclosed document is incomplete or not certified.

Articles of Incorporation of the applicant Company.QuestionCriticalDue Jul 30, 2026

Make sure that the Articles of Incorporation of the applicant company is complete and verify if it is the latest date of document with Chamber of Commerce.

The enclosed document, Articles of Incorporation of the Applicant Company is incomplete or missing details. Kindly resubmit.

Articles of Incorporation for intermediate company(ies)QuestionCriticalDue Jul 30, 2026

Articles of Incorporation for intermediate company(ies) or holding company (ies) 10% or more shareholding in the applicant company

The enclosed document, Articles of Incorporation of the Company/holding is incomplete or missing details. Kindly resubmit.

Business PlanQuestionCriticalDue Aug 26, 2026

Reviewed if the business plan contains at least: 1. An overview of the business products and services/brands as well as proprietary IP 2. Company management structure showing key management roles and reporting lines. 3. Business forecasts for 3 years. 4. Overview of intended strategy for the business growth and to secure/maintain/grow market share with specific financial and marketing plans

Please include the names of those holding c-suite level positions (CEO, CFO, CTO, etc.) in the company management structure outlined in the business plan or state if they are yet to be hired. (Note that the management structure must also align with Section 12 of the Business and Corporate Information Form.) Please update the business plan accordingly and resubmit it.

goAML RegistrationQuestionCriticalDue Aug 26, 2026

A screenshot of the goAML registration of the Curacao entity.

The screenshot submitted is not the correct screenshot. Please submit a screenshot of the <u>admin page</u> when logged in to the goAML portal. To do this, log in to the goAML portal, click Admin, select Active Organizations and take a screenshot of the page. Please upload the screenshot to the goAML Registration section.

Source of Funds of BusinessQuestionCriticalDue Aug 26, 2026

If applicable, evidence of 3rd party or shareholder loans is missing.

<p>Please submit a certified copy of the shareholder loan agreement, which is expected to outline the key terms, including the funding, and any interest on the loan and the repayment terms (if applicable). The loan agreement must be signed by all parties and certified as a true copy.</p>

Note: Pending confirmation of currency of shareholder loan of 10,000 (currency not indicated on BCIF). Loan amount may not be sufficient. To be reviewed further once the loan agreement is received.
[Sarah Cathalina-Labbe - 17-07-2026 18:51]
Declaration of Good StandingMiscellaneousCriticalDue Aug 26, 2026

Please provide a certified copy of the Declaration of Good Standing (verzoek verklaring betalingsgedrag) of Ansom B.V. Please note that the Declaration of Good Standing must be the official document issued by the Tax Authorities with the stamp of 'ontvanger' and the 'invorderaar' and it must be certified as a true copy.

Please provide a certified copy of the Declaration of Good Standing (verzoek verklaring betalingsgedrag) of Ansom B.V. Please note that the Declaration of Good Standing must be the official document issued by the Tax Authorities with the stamp of 'ontvanger' and the 'invorderaar' and it must be certified as a true copy.

Financial AccountsFinancial AuditCriticalDue Aug 26, 2026

Please provide the 2025 financial statements in whatever form.

Please provide the 2025 financial statements in whatever form.

Personal History Disclosure FormCritical35 items
CGA Personal History Disclosure FormIncomplete FormCriticalDue Jul 31, 2026

Check document.Inspect all pages to ensure that there are no blank pages The applications must be filled in digitally. No forms shall be accepted where the customer has completed any section of the form handwritten. Check the forms and make sure there are no ink marks or handwritten notes.

The Personal History Disclosure form is not the official form supplied by CGA. Kindly download the appropriate form, refill digital and resubmit.

Page 1: Application NumberIncomplete FormCriticalDue Jul 31, 2026

Check document. Make sure that this is filled and the same as that shown on the portal

The personal application number is missing or has an incorrect application number. Kindly resubmit the forms with the correct application number.

Page 1: Application DateQuestionCriticalDue Aug 26, 2026

Check document. The application date must be filled and within six month`s of today`s date.

The application date is more than one year old. Please resubmit the form with the correct application date.

Page 1: Personal Information Section - Question 1: First NameQuestionCriticalDue Jul 31, 2026

Check if information matches the passport.

The applicant`s first name is incorrect or does not match.Kindly resubmit the form with the correct first name.

Page 1: Personal Information Section - Question 2: Last NameQuestionCriticalDue Jul 31, 2026

Check if information matches the passport.

The applicant`s last name is incorrect or does not match.Kindly resubmit the form with the correct lasr=t name.

Page 1: Personal Information Section - Question 6: DOBQuestionCriticalDue Jul 31, 2026

Check if information matches the passport.

The Date of birth (DOB) of the applicant is missing or incorrect. Kindly resubmit the forms with the correct DoB.

Page 1: Personal Information Section - Question 7 and 8: Former namesQuestionCriticalDue Jul 31, 2026

Check if applicant has submitted certified proof of previous names.

Kindly provide certified proof of name change documents.

Page 1:Personal Information Section - Question 11QuestionCriticalDue Jul 31, 2026

Must not be blank.

The response to Question 11 is missing. Kindly complete Question 11 and resubmit the form.

Page 1: Personal Information Section - Question 12QuestionCriticalDue Jul 31, 2026

Must not be blank. personal email address

The response to Question 12 is missing. Kindly complete Question 12 and resubmit the form.

Page 2: Contact Details Section - Question 13QuestionCriticalDue Jul 31, 2026

Must not be blank. Email address

The response to Question 13 is missing. Kindly complete Question 13 and resubmit the form.

Page 2: Contact Details Section - Question 14QuestionCriticalDue Jul 31, 2026

Must not be blank. Mobile number

The response to Question 14 is missing. Kindly complete Question 14 and resubmit the form.

Page 2: Citizenship Section - Question 15QuestionCriticalDue Jul 31, 2026

Check if matches the passport. Place of Birth must not be blank.

The response to Question 15 is missing. Kindly complete Question 15 and resubmit the form.

Page 2: Citizenship Section - Question 16QuestionCriticalDue Jul 31, 2026

Must not be blank and check if matches the passport. Passport number must not be blank.

The response to Question 16 is missing. Kindly complete Question 16 and resubmit the form.

Page 2: Citizenship Section - Question 17QuestionCriticalDue Jul 31, 2026

Check if matches the passport. Country of Issue must not be blank.

The response to Question 17 is missing. Kindly complete Question 17 and resubmit the form.

Page 2: Citizenship Section - Question 18QuestionCriticalDue Jul 31, 2026

Check if matches the passport. Date of Issue must not be blank.

The response to Question 18 is missing. Kindly complete Question 18 and resubmit the form.

Page 2: Citizenship Section - Question 19QuestionCriticalDue Jul 31, 2026

Check if matches the passport. Date of Expiry must not be blank.

The response to Question 19 is missing. Kindly complete Question 19 and resubmit the form.

Page 2: Citizenship Section - Question 20QuestionCriticalDue Jul 31, 2026

Check if matches the passport. Nationality/ Citizenship

The response to Question 20 is missing. Kindly complete Question 20 and resubmit the form.

Page 5: Key Person Involvement Section - Question 27QuestionCriticalDue Jul 31, 2026

Must be filled. If the Local Executive Director(official representative) is selected the name of the local service provider must be filled in. If other Key Function Holder is selected, then the function must be filled.

The name of the local service provider or the function of the person in the company is missing. Kindly fill in and resubmit the form.

Page 5: Key Person Involvement Section - Question 28QuestionCriticalDue Jul 31, 2026

If question 28 is filled then question 28.1. must be filled.

The response to question 28.1 is missing. Kindly fill in and resubmit.

Page 5: Key Person Involvement Section - Question 30QuestionCriticalDue Jul 31, 2026

Must be filled.

The response to question 30 is missing. Kindly fill in and resubmit.

Page 5: Key Person Involvement Section - Question 31QuestionCriticalDue Jul 31, 2026

Must be filled.

The response to question 31 is missing. Kindly fill in and resubmit.

Page 7: Present Employment Section - Question 34 and 39QuestionCriticalDue Jul 31, 2026

They must provide evidence of present employment.

The proof for question 34 and 39 is missing. Kindly upload in the section of extra documentation.

Page 8: Source of Wealth Section - Question 41 - 42QuestionCriticalDue Jul 31, 2026

Must be filled.

The response for question 41 and or 42 is missing. Kindly fill in and resubmit.

Page 8: Source of Wealth Section - Question 43QuestionCriticalDue Jul 31, 2026

Must be filled. At least one must be selected, if 43.11 is selected then other Income must be filled.

The response to question 43 is missing. (if applies 43.11 must be filled) Kindly fill in and resubmit the form.

Page 8: Question 44QuestionCriticalDue Jul 31, 2026

If yes is selected, 44.1. must be filled.

The response to 44.1. is missing. Kindly fill in and resubmit the form.

Page 9: Declaration and Data PrivacyMiscellaneousCriticalDue Aug 26, 2026

The document must contain the name and surname and digital signature of the person that filled the form on Page 9.

Please sign the form digitally and resubmit it. Copy/pasted signatures are not accepted.

PassportPassportCriticalDue Aug 26, 2026

Check date and make sure the passport is not expired.Make sure that persons photo is clear and recognizable.

The copy of the passport cannot be accepted because the date of certification is more than six months old. Please submit a copy of the passport that has been certified as a true copy within the last six months.

Criminal RecordCriminal RecordCriticalDue Aug 26, 2026

Check the document and make sure it is in english language or if translated from another language, the translated document, must be certified. Check date and make sure the certificate is not expired (not older than 6 months). It must be submitted for every jurisdiction whereby the applicant resided for more than six months in the last two years.

The criminal record cannot be accepted because it was issued more than six months ago. Please provide a certified true copy of the criminal record issued within the last six months.

Birth CertificateBirth CertificateCriticalDue Aug 26, 2026

Check the document and make sure it is in English Language or orginal document with translation. Both have to be certified. (In some cases we accept the Marriage Certificate)

<p>The declaration submitted indicates that a copy of Anil Sushil Jain's birth certificate was requested on 28/05/2025. Please provide a certified copy of the birth certificate. </p><p>If it is not possible to provide a copy of the birth certificate due to the ongoing geo-political challenges in the region mentioned in the declaration, please provide another document issued by the local government/civil registry. The document must show the person's full name, date of birth, place of birth, and parents' names and must be certified as a true copy. </p><p>Note: any document not in English must be accompanied by an English translation certified by the translator.</p>

Proof of Address (Utility Bill)Proof of AddressCriticalDue Aug 26, 2026

Make sure that this document is in English or translated in English language and certified. Check if the address is a residential address. Check date and make sure the date is within the last six months.

The proof of address document cannot be accepted because it was issued more than six months ago. Please submit a certified copy of a proof of address document (utility bill) issued within the last six months.

Bank Reference LetterReference LetterCriticalDue Aug 26, 2026

Make sure that it is in the applicant name verifying their personal account.Check date and make sure the certificate is not expired (not older than 6 months).

Please submit a bank reference letter issued on official bank letterhead within the last six months and certified as a true copy.

Letter of appointment/ Engagement agreement as Key Person.Reference LetterCriticalDue Jul 31, 2026

Check document. (mandatory for compliance officers)

The letter of appointment/ engagement agreement is missing/incomplete. Kindly resubmit/ submit.

Personal Gaming Authorisations from Other JurisdictionsReference LetterMediumDue Jul 31, 2026

Certified true copies of any Gaming License issued in favor of the applicant in a personal capacity from any jurisdiction ( eg. UK Personal Management License)

The Certified true copies of Gaming License issued in favor of personal capacity is missing/incomplete. Kindly submit.

Curriculum Vitae (CV)Curiculum VitaeCriticalDue Jul 31, 2026

Check document. (mandatory for compliance officers)

Proof of EmploymentMiscellaneousCriticalDue Aug 26, 2026

Please provide proof of the current employment as declared in questions 34 - 39 on the Personal History Disclosure Form. All documents submitted must be certified as true copies.

Please provide proof of the current employment as declared in questions 34 - 39 on the Personal History Disclosure Form. All documents submitted must be certified as true copies.

Qualifying PersonsCritical2 items
Managing Director - Jonathan HeymansMiscellaneousCriticalDue Aug 26, 2026

Please add Jonathan Heymans to the portal as a qualifying person and upload the Personal History Disclosure Short Form.

Please add Jonathan Heymans to the portal as a qualifying person and upload the Personal History Disclosure Short Form.

Managing Director - Maya BaroudMiscellaneousCriticalDue Aug 26, 2026

Please add Maya Baroud to the portal as a qualifying person and upload the Personal History Disclosure Form and enclosures (with the exception of source of wealth).

Please add Maya Baroud to the portal as a qualifying person and upload the Personal History Disclosure Form and enclosures (with the exception of source of wealth).

Personal History Disclosure FormCritical35 items
CGA Personal History Disclosure FormIncomplete FormCriticalDue Aug 3, 2026

Check document.Inspect all pages to ensure that there are no blank pages The applications must be filled in digitally. No forms shall be accepted where the customer has completed any section of the form handwritten. Check the forms and make sure there are no ink marks or handwritten notes.

The Personal History Disclosure form is not the official form supplied by CGA. Kindly download the appropriate form, refill digital and resubmit.

Page 1: Application NumberIncomplete FormCriticalDue Aug 3, 2026

Check document. Make sure that this is filled and the same as that shown on the portal

The personal application number is missing or has an incorrect application number. Kindly resubmit the forms with the correct application number.

Page 1: Application DateQuestionCriticalDue Aug 26, 2026

Check document. The application date must be filled and within six month`s of today`s date.

The application date is more than one year old. Please submit the form with the current date.

Page 1: Personal Information Section - Question 1: First NameQuestionCriticalDue Aug 3, 2026

Check if information matches the passport.

The applicant`s first name is incorrect or does not match.Kindly resubmit the form with the correct first name.

Page 1: Personal Information Section - Question 2: Last NameQuestionCriticalDue Aug 3, 2026

Check if information matches the passport.

The applicant`s last name is incorrect or does not match.Kindly resubmit the form with the correct lasr=t name.

Page 1: Personal Information Section - Question 6: DOBQuestionCriticalDue Aug 3, 2026

Check if information matches the passport.

The Date of birth (DOB) of the applicant is missing or incorrect. Kindly resubmit the forms with the correct DoB.

Page 1: Personal Information Section - Question 7 and 8: Former namesQuestionCriticalDue Aug 3, 2026

Check if applicant has submitted certified proof of previous names.

Kindly provide certified proof of name change documents.

Page 1:Personal Information Section - Question 11QuestionCriticalDue Aug 3, 2026

Must not be blank.

The response to Question 11 is missing. Kindly complete Question 11 and resubmit the form.

Page 1: Personal Information Section - Question 12QuestionCriticalDue Aug 3, 2026

Must not be blank. personal email address

The response to Question 12 is missing. Kindly complete Question 12 and resubmit the form.

Page 2: Contact Details Section - Question 13QuestionCriticalDue Aug 3, 2026

Must not be blank. Email address

The response to Question 13 is missing. Kindly complete Question 13 and resubmit the form.

Page 2: Contact Details Section - Question 14QuestionCriticalDue Aug 3, 2026

Must not be blank. Mobile number

The response to Question 14 is missing. Kindly complete Question 14 and resubmit the form.

Page 2: Citizenship Section - Question 15QuestionCriticalDue Aug 3, 2026

Check if matches the passport. Place of Birth must not be blank.

The response to Question 15 is missing. Kindly complete Question 15 and resubmit the form.

Page 2: Citizenship Section - Question 16QuestionCriticalDue Aug 3, 2026

Must not be blank and check if matches the passport. Passport number must not be blank.

The response to Question 16 is missing. Kindly complete Question 16 and resubmit the form.

Page 2: Citizenship Section - Question 17QuestionCriticalDue Aug 26, 2026

Check if matches the passport. Country of Issue must not be blank.

Please enter the country of issue of the passport (not the local jurisdiction where the passport was issued).

Page 2: Citizenship Section - Question 18QuestionCriticalDue Aug 26, 2026

Check if matches the passport. Date of Issue must not be blank.

The date of issue entered is incorrect. Please enter the correct date.

Page 2: Citizenship Section - Question 19QuestionCriticalDue Aug 3, 2026

Check if matches the passport. Date of Expiry must not be blank.

The response to Question 19 is missing. Kindly complete Question 19 and resubmit the form.

Page 2: Citizenship Section - Question 20QuestionCriticalDue Aug 3, 2026

Check if matches the passport. Nationality/ Citizenship

The response to Question 20 is missing. Kindly complete Question 20 and resubmit the form.

Page 5: Key Person Involvement Section - Question 27QuestionCriticalDue Aug 3, 2026

Must be filled. If the Local Executive Director(official representative) is selected the name of the local service provider must be filled in. If other Key Function Holder is selected, then the function must be filled.

The name of the local service provider or the function of the person in the company is missing. Kindly fill in and resubmit the form.

Page 5: Key Person Involvement Section - Question 28QuestionCriticalDue Aug 3, 2026

If question 28 is filled then question 28.1. must be filled.

The response to question 28.1 is missing. Kindly fill in and resubmit.

Page 5: Key Person Involvement Section - Question 30QuestionCriticalDue Aug 3, 2026

Must be filled.

The response to question 30 is missing. Kindly fill in and resubmit.

Page 5: Key Person Involvement Section - Question 31QuestionCriticalDue Aug 3, 2026

Must be filled.

The response to question 31 is missing. Kindly fill in and resubmit.

Page 7: Present Employment Section - Question 34 and 39QuestionCriticalDue Aug 3, 2026

They must provide evidence of present employment.

The proof for question 34 and 39 is missing. Kindly upload in the section of extra documentation.

Page 8: Source of Wealth Section - Question 41 - 42QuestionCriticalDue Aug 3, 2026

Must be filled.

The response for question 41 and or 42 is missing. Kindly fill in and resubmit.

Page 8: Source of Wealth Section - Question 43QuestionCriticalDue Aug 3, 2026

Must be filled. At least one must be selected, if 43.11 is selected then other Income must be filled.

The response to question 43 is missing. (if applies 43.11 must be filled) Kindly fill in and resubmit the form.

Page 8: Question 44QuestionCriticalDue Aug 3, 2026

If yes is selected, 44.1. must be filled.

The response to 44.1. is missing. Kindly fill in and resubmit the form.

Page 9: Declaration and Data PrivacyMiscellaneousCriticalDue Aug 26, 2026

The document must contain the name and surname and digital signature of the person that filled the form on Page 9.

The DECLARATION AND DATA PRIVACY page is not signed. The form must be digitally signed (copy/pasted signatures are not accepted).

PassportPassportCriticalDue Aug 26, 2026

Check date and make sure the passport is not expired.Make sure that persons photo is clear and recognizable.

The certification on the passport is more than six months old. Please submit a copy of the passport certified as a true copy within the last six months.

Criminal RecordCriminal RecordCriticalDue Aug 26, 2026

Check the document and make sure it is in english language or if translated from another language, the translated document, must be certified. Check date and make sure the certificate is not expired (not older than 6 months). It must be submitted for every jurisdiction whereby the applicant resided for more than six months in the last two years.

The criminal record was issued more than six months ago and is not certified as a true copy. Please submit a certified copy of a criminal record issued within the last six months.

Birth CertificateBirth CertificateCriticalDue Aug 26, 2026

Check the document and make sure it is in English Language or orginal document with translation. Both have to be certified. (In some cases we accept the Marriage Certificate)

<p>Please submit:</p><ol><li>A certified true copy of the original birth certificate document in the original language.</li><li>The English translation of the document must include a statement from the translator confirming that the document is a true translation from the original language, and must include the full name, signature and contact details of the translator.</li></ol>

Proof of Address (Utility Bill)Proof of AddressCriticalDue Aug 26, 2026

Make sure that this document is in English or translated in English language and certified. Check if the address is a residential address. Check date and make sure the date is within the last six months.

<p>The proof of address document cannot be accepted because it was issued more than six months ago and it has the address of the previous place of residence as declared on the Personal History Disclosure Form. </p><p>Please submit a proof of address document (utility bill) for the current residence issued within the last six months.</p>

Bank Reference LetterReference LetterCriticalDue Aug 26, 2026

Make sure that it is in the applicant name verifying their personal account.Check date and make sure the certificate is not expired (not older than 6 months).

The bank reference letter was issued more than six months ago and is not certified. Please submit a certified true copy of a bank reference letter on official bank letterhead issued within the last six months.

Letter of EngagementReference LetterCriticalDue Aug 26, 2026

Check document. (mandatory for compliance officers)

Please submit a letter of engagement signed by both the compliance officer and the managing director.

Personal Gaming Authorisations from Other JurisdictionsReference LetterMediumDue Aug 3, 2026

Certified true copies of any Gaming License issued in favor of the applicant in a personal capacity from any jurisdiction ( eg. UK Personal Management License)

The Certified true copies of Gaming License issued in favor of personal capacity is missing/incomplete. Kindly submit.

Curriculum Vitae (CV)Curiculum VitaeCriticalDue Aug 26, 2026

Check document. (mandatory for compliance officers)

<p>Please upload a CV in English to the "Letter of Engagement" section of the portal.</p>

Source of Wealth for the UBO OnlySource of WealthCriticalDue Aug 3, 2026

The Source of Wealth must demonstrate the UBO`s financial standing and confirm their ability to operate and support the company.

The Source of Wealth documentation for the Shareholders/UBO was not provided/or is invalid.Kindly resubmit the required documents, including certified bank statements clearly displaying amounts and dividends, tax returns evidencing earnings, or any other certified documentation demonstrating the source of wealth of the UBO,and ensure that all certifications are made as true copies by authorized persons such as legal or accountancy professionals, regulated financial institutions, or other duly empowered authorities within the relevant jurisdiction.