Application for Variation or Cancellation of
Conditions of Licence
(Section 120, Sale and Supply of Alcohol Act 2012)
Application Checklist:
Supporting documents you need to provide with your application:
Application fee plus public notice fee
This is an application fee and is non-refundable after the application is received by
Matamata Piako District Council. (Please see information sheet on the last two pages of this
application or contact us for assistance).
Detailed A4 scale map of the interior of the premises showing:
the areas used for sale of alcohol
the areas that are to be restricted or supervised
the principal entrance
location of tables and chairs, toilets and kitchen
the use of footpath for outdoor dining (if applicableattach outdoor dining permit)
CCTV placement and security lighting (if applicable)
A Host Responsibility Policy.
Supporting documentation relevant to the condition(s) to be varied or cancelled
If a redefinition is sought relevant to the area (footprint) of the licensed premises or a change in
the purpose (i.e. restaurant to tavern), a new building and planning certificate may be required.
If you are applying for the variation or cancellation of conditions of the licence on behalf of someone
A copy of the authority to act as an agent of the applicant, signed by the applicant
Fee due:
Send the completed application form and attachments to:
Liquor Licensing Department
Matamata-Piako District Council
PO Box 266
Te Aroha, 3342
Application for Variation or Cancellation
of Conditions of Licence
(Section 120, Sale and Supply of Alcohol Act 2012)
To the Secretary
District Licensing Committee, Matamata Piako District Council
Application for variation or cancellation of conditions of licence is made in accordance with the details
set out below.
Applicant details
Full legal name to appear on licence:
(the licensee, i.e. the person or organisation that the proceeds from alcohol sales are going to):
Date of birth (if the applicant is an individual):
Occupation (if the applicant is an individual):
Status of applicant:
Individual person
Licensing trust or community trust
(advise what authority under which incorporated)
Private company
Public company
Local authority
Postal address (for service of documents):
______________________________________________ Postcode:
Home phone:___________________________ Work phone:
Mobile phone:
E-mail address:
Daytime contact details (if different from above)
Phone number: _________________________ Mobile number:
E-mail address:
Does the applicant (or any company directors) have any criminal convictions?
Yes No
(other than convictions for offences against provisions of the Land Transport Act 1998 not contained in
Part 6, and offences to which the Criminal Records (Clean Slate) Act 2004 applies)
If YES, please state the nature of the offence, date of conviction and penalty suffered:
Nature of the offence
Date of conviction
Penalty suffered
What experience and training does the applicant have relative to operating licensed premises?
Licence details
Type of licence:
Club licence
Licence number: Expiry date:
Premises details
Address of licensed premises:
Trading name:
Does the applicant own the proposed licensed premises?
Yes No
If NO, what is the full name and address of the owner?
What form of tenure and term of tenure will the applicant have?
Details of Conveyance
To be included only where the licence applies to any conveyance, e.g. bus, train, boat
Type of conveyance
Address of home base (if any)
Trading or other name (if any)
Registration number (if any)
Application details
Terms of condition at present:
Action sought: Variation of condition(s) Cancellation of condition(s)
If variation, in what respect does the applicant seek to vary the condition?
Full reasons for variation or cancellation:
The New Zealand police are required by the Sale and Supply of Alcohol Act 2012 to make inquiries
into the suitability of the applicant. This will involve informing the District Licensing Committee and the
Alcohol Regulatory and Licensing Authority of any convictions or concerns involving the applicant.
Should there be any concerns, the applicant will also be informed.
I consent to the release of this information
I hereby state that the above particulars are true and correct
I understand that my application will not be lodged with Council until the application fee is paid
and all required documents are supplied. Incomplete applications will be returned.
Applicant name: Designation:
Signature: _________________ ________ Date:
Contact us:
Phone: (07) 884 0060
Location: 35 Kenrick Street, Te Aroha
Alcohol Licensing Fees
The Sale and Supply of Alcohol Act 2012 has introduced national risk based fees for all alcohol
licences. The new fee system, set by the Ministry of Justice, more fairly reflects the cost of
alcohol licensing.
The licence fee category is determined using the below criteria. You can use the tables below to
estimate the fee you need to pay when lodging your application.
Licence type
Type of Premises
Class 1 restaurant, night club, tavern, adult premises
Class 2 restaurant, hotel, function centre
Class 3 restaurant, other
BYO restaurant, theatres, cinemas, winery cellar doors
Supermarket, grocery store, bottle store
Hotel, tavern
Class 1, 2 or 3 club, remote sale premises, other
Winery cellar doors
Club licence
Class 1 club
Class 2 club
Class 3 club
Licence type
Latest trading hour allowed by licence
On-licence or club
2:00am or earlier
Between 2:01am and 3:00am
Any time after 3:00am
Off-licence (excl.
remote sales premises)
10:00pm or earlier
Any time after 10:00pm
Remote sales
Not applicable
Licence type
Number of enforcement holdings in last 18 months
All licence types
2 or more
Your weighting:
Class 1 restaurants restaurants with a significant separate bar area which, in the opinion of
Matamata Piako District Council, operate that bar at least one night a week in the nature of a tavern,
such as serving alcohol without meals to tables situated in the bar area.
Class 2 restaurants restaurants that have a separate bar (which may include a small bar area) but
which, in the opinion of Matamata Piako District Council, do not operate that area in the nature of tavern
at any time.
Class 3 restaurants restaurants that only serve alcohol to the table and do not have a separate bar
Class 1 clubs clubs which, in the opinion of Hamilton City Council, are large clubs (with 1,000 or more
members of purchase age) and which, in the opinion of Hamilton City Council, operate in the nature of a
tavern (for example a large working men's club, combined clubs, or large 'cossie' clubs).
Class 2 clubs clubs which do not fit class 1 or class 3 definitions (for example larger sports clubs,
medium sized RSAs, many provincial social clubs).
Class 3 clubs - clubs which, in the opinion of Hamilton City Council, are small clubs (with fewer than
250 members of purchase age) and which operate a bar for 40 hours or less per week (for example
small sports clubs like bowling clubs, golf clubs, bridge clubs, and small RSAs).
Enforcement has the same meaning as a “Holding” under section 288 of the Act, or a previous
offence for which a holding may have been issued if the offence had occurred before 18 December
Application Fee
The licensing system has five fee categories, which reflect the range of cost/risk ratings. A premises'
fee category determines the application fee that the licensee has to pay.
Total weighting
Fee category
Total application fee
Very Low
Very High
Annual Fee
The new Act also introduces an annual fee for all licences. The annual fee is due before the licence is
issued (for new licences) and then every year on the licence anniversary date. The amount of the annual fee
you pay will be determined on the fee category and risk rating at the day the annual fee is due. You will
receive a reminder that your annual fee is due in the mail prior to the due date. All fees below are GST
Fee Category
Annual Fee
Very Low
Very High
Please note that it is Matamata Piako District Council that determines the final application and annual fees
so you may be charged further fees before your licence is granted.
All fees are set by the Ministry of Justice. For more information, see If you need
assistance calculating your fees, please contact us on the details below.
Contact us:
Phone: (07) 838 6633
Location: 35 Kenrick Street, Te Aroha