I.C.L.R.A

User Registration

ICLRA New Account User Registration Form

First Name

Middle Name

Last Name

Password

Phone/Mobile

Residential Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Postal Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Date Born

Identification verification-
Minimum Requirements- Birth Certificate/Passport

and 1 x Photo Identification

or select 2 options below:

1 x Medicare Card
1 x Bank Card

1 x Pension Card

ID upload

Choose File

I declare that the information and documents I have provided are true, complete, and accurate to the best of my knowledge. I understand that knowingly providing false, misleading, altered, or fraudulent information may result in refusal, suspension, or cancellation of my registration or licence, and may lead to any further action available under applicable law or the governing rules of the Authority. I consent to the International Crown Licensing Regulatory Authority (ICLRA) collecting, storing, verifying, and using my personal information and identity documents for the purposes of identity verification, account administration, licensing, compliance, record management, fraud prevention, and related administrative functions. I acknowledge that, upon successful registration, I will be assigned a unique Crown Registration Number (CRN), which will serve as my permanent identifier for records maintained by the Authority. I understand that my CRN may be used to link future applications, licences, correspondence, and other authorised records associated with my account. I confirm that I have read and agree to the applicable Terms and Conditions, Privacy Policy, and any policies governing my registration and use of the Authority’s services.