Individual account request form

Further information about the QRIC’s commitment to privacy is available from our website https://www.qric.qld.gov.au/privacy/

This information is collected to enable the QRIC or the Controlling Body to contact a person nominated by you in the event of an accident or emergency. The QRIC or the Controlling Body may disclose this information to third parties.
The following fields are required if you intend to apply for a licence.

Do you have a current Greyhound, Harness or Thoroughbred licence in Queensland?

NoYes

You must be 18 years of age to have an online account and applying for licences and registration with the Queensland Racing and Integrity Commission. If you are under the age of 18 years, please apply using the appropriate forms from the Queensland Racing Integrity Commission web site.

Date of birth

Current year

Name of applicant

First name

Middle name(s)

Last name

Preferred name

Place of birth

Sex

Please specify

Place of residence

Street address

State

Suburb

State

Suburb

Country

Place of residence

Postal address

Same as above

Street address / Post box

State

Suburb

State

Suburb

Country

Postal address

Contact details

At least 1 phone number is required

Phone

Mobile phone

Preferred contact method

Emergency contact

Name

Contact phone number

Relationship to applicant

Applicant declaration and privacy statement

Your personal information (including name, contact number and email address) is being collected by the Queensland Racing Integrity Commission (QRIC) to provide you with the services you request through this account.

I consent to the QRIC disclosing my personal information to and obtaining information in relation to a bet or bets I place (in my own capacity or on behalf of any other person) from any entity operating:

A totalisator operator in Australia or elsewhere;
A bookmaker licensed to operate in Australia or elsewhere, including corporate bookmakers;
A betting exchange (licensed or unlicensed) operating in Australia or elsewhere.

I understand that any entity that provides information to the QRIC in compliance with a request made by QRIC does so with my consent and is not breaching the Information Privacy Act 2009 (Qld) or any other State or Commonwealth legislation concerning the protection of information concerning my personal affairs, in complying with the request by the QRIC.

I am aware and understand that it is an offence under section 214 of the RIA for me to knowingly make a false statement in an application for a licence. Subject to a maximum penalty of 200 penalty units or 2 years’ imprisonment.

I declare that I am 18 years or over.

I have read and understood the above declaration and privacy statement.

agree new account required