FINANCIAL AUDIT SERVICES _part6 ppt

THE COMPLETION OF THIS BUSINESS DISCLOSURE FORM IS A REQUIREMENT OF THE SCIENTIFIC GAMES CORPORATION “SGC” COMPLIANCE PROGRAM.. YOU ARE REQUIRED TO DISCLOSE IMMEDIATELY TO SCIENTIFIC GAM

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BUSINESS DISCLOSURE FORM

TYPE OR PRINT LEGIBLY AN ANSWER TO EVERY QUESTION IF A QUESTION DOES NOT APPLY, SO STATE WITH “N/A” IF SPACE IS INSUFFICIENT, CONTINUE ON A SEPARATE PAGE AND PRECEDE EACH ANSWER WITH THE APPROPRIATE SECTION NUMBER AND TITLE DO NOT MISSTATE OR OMIT ANY MATERIAL FACT(S) AS INFORMATION PROVIDED IS SUBJECT TO VERIFICATION THE AUTHORIZED COMPANY REPRESENTATIVE RESPONSIBLE FOR COMPLETING THE FORM MUST INITIAL EACH PAGE, INCLUDING ATTACHED SHEETS BY INITIALING EACH PAGE, THE COMPANY REPRESENTATIVE IS ATTESTING TO THE ACCURACY AND COMPLETENESS OF THE INFORMATION CONTAINED ON THAT PAGE

THE COMPLETION OF THIS BUSINESS DISCLOSURE FORM IS A REQUIREMENT OF THE SCIENTIFIC GAMES CORPORATION (“SGC”) COMPLIANCE PROGRAM MISREPRESENTATION OR FAILURE TO PROVIDE THE INFORMATION REQUESTED MAY BE CONSIDERED SUFFICIENT CAUSE FOR THE REFUSAL TO ENTER INTO OR REVOCATION OF AN AGREEMENT WITH SGC OR ANY OF ITS SUBSIDIARY COMPANIES ADDITIONALLY, YOU ARE ADVISED THAT ANY FACT NOT DISCLOSED HEREIN THAT WOULD HAVE CAUSED SCIENTIFIC GAMES NOT TO ENTER INTO AGREEMENT WITH YOU IS SUFFICIENT CAUSE FOR THE IMMEDIATE TERMINATION OF ANY SUCH AGREEMENT AND ENTITLES SCIENTIFIC GAMES TO ANY DAMAGES CAUSED BY FAILURE TO DISCLOSE THIS FACT YOU ARE REQUIRED TO DISCLOSE IMMEDIATELY TO SCIENTIFIC GAMES ANY CHANGE IN THE INFORMATION REPORTED ON THIS FORM THAT OCCURS SUBSEQUENT TO THE COMPLETION OF THIS FORM IT IS UNDERSTOOD THAT ANY SUCH CHANGE IN INFORMATION WILL BE EVALUATED

BY SCIENTIFIC GAMES AND THAT SCIENTIFIC GAMES MAY CHOOSE AT ITS DISCRETION TO TERMINATE ANY AGREEMENT WITH YOU AS A RESULT OF THIS INFORMATION

FOR PURPOSES OF THIS DISCLOSURE FORM, SGC REFERS TO ANY OF ITS SUBSIDIARY OR AFFILIATE COMPANIES, INCLUDING BUT NOT LIMITED TO, SCIENTIFIC GAMES INTERNATIONAL, INC., AND MDI ENTERTAINMENT, LLC

1 GENERAL BUSINESS INFORMATION D ATE : _

Name of Business: _

Business Address: _

Street City

State Country Zip Code

Business Telephone: Fax:

(Include Area Code or Country Code)

E-mail Address: _ Web site:

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Trade name to be used: _ Other name(s) by which the company has been known:

_

Federal Tax ID Number (if applicable): _ Describe the principal nature of the company’s business: _

_ List all states and jurisdictions in which business is conducted:

2 RELATIONSHIP WITH SCIENTIFIC GAMES CORPORATION (“SGC”):

A Briefly describe your company’s current or proposed business relationship with SGC:

B Does your company have a signed contract or any type of agreement with SGC? YES _ NO

C Name of the person(s) with SGC that serve(s) as your company’s primary contact

D Name of the person(s) with your company that serve(s) as SGC’s primary contact List

the name and title of those persons in the company who will be taking an active management role in the business arrangement with SGC

E List any present or past business associations your company has had with any other

business entity involved in the racing, gaming, casino or lottery industries Provide the business name and a brief description of the business relationship

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3 BUSINESS INFORMATION

If business is a corporation, complete section A; if business is a partnership, complete section B

SECTION A – CORPORATION

(1) Name and Address of Corporation as filed in the current Articles of Incorporation:

(2) Place of Incorporation _ (3) Date and Year of Incorporation _ (4) Current Board of Directors and Key Officers: (Chief Executive Officer, President, Secretary, Treasurer, Chief Operating Officer, and Chief Financial Officer)

_

(5) Please provide the following information on all shareholders owning over 5% of the current issued and outstanding shares of the business

_

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(6) If applicable, list the parent company and all subsidiary companies of your business Provide for each company the information requested below:

Company Name Address Telephone

Principal Officer Description of Business Affiliation

(parent or subsidiary) _

(parent or subsidiary)

_

(7) If applicable, provide name of stock exchange and trading symbol for all publicly traded companies _ _

SECTION B – PARTNERSHIP

(1) Name and Address of Partnership in current Partnership Agreement

(2) Place Partnership was formed: Date: (3) Original or Founding Partners:

_

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(4) Current Partners (if different from above):

_

4 (AT THE PRESENT TIME IT IS NOT NECESSARY TO COMPLETE SECTION 4,

UNLESS YOU ARE CONTACTED BY SGC COMPLIANCE PERSONNEL.)

PERSONS REQUIRED TO COMPLETE A PERSONAL DISCLOSURE FORM

A For purposes of this document, a “Control Person” is any person or entity that has the

ability to control or influence the decisions made by management of the business.

Persons or entities identified under Items 3.A (4) and 3.B (4) are considered to be

“Control Persons.” Inside directors listed under 3.A (4), who hold management positions within the corporation, are required to complete a separate Personal Disclosure Form, which must be filed with this form Outside directors are NOT required to complete a Personal Disclosure Form

B Any business listed under 3.A (5), which owns over 5% of the company’s issued and outstanding stock is required to complete a Business Disclosure Form However, any

“Control Person” of that business is NOT required to complete or provide a Personal Disclosure Form, unless they are also a “Control Person” listed for the business under 3.A (4)

C Any person listed under 3.A (5), which owns over 5% of the company’s issued and

outstanding stock, is required to complete a Personal Disclosure Form However, an institutional investor registered with the Securities and Exchange Commission under Section 203 of the Investment Advisors Act or Section 8 of the investment Company Act

is NOT required to complete a Personal Disclosure Form

5 LICENSING INFORMATION

A Has this Business ever applied for any licenses, findings of suitability or other similar approval in any jurisdiction for the gaming, casino, racing, or lottery industries?

YES _ NO

If YES, provide details List the name of each gaming jurisdiction where an application is pending or where a license has been issued List the type of license applied for or issued and effective dates

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