Checklist
Club Licence or Renewal of Club Licence
Sale and Supply of Alcohol Act 2012
The following must be included in your application or it will be returned
Please tick when completed:
Fees
Application and Annual Fees are set by a cost/risk framework under
the Sale and Supply of Alcohol (Fees) Regulations 2013. Information
about the fee framework is available on your local council’s website.
Fees include GST and are non-refundable.
If it is determined that your fee category should be changed, any
additional fee must be paid before the licence is issued.
For new applications, the application fee must be paid when the form
is submitted, and the annual fee must be paid any time before the
licence is issued. For all other applications, fees must be paid when the
application is submitted.
Fee category Application fee Annual fee
Very low $368 $161
Low $609.50 $391
Medium $816.50 $632.50
High $1023.50 $1035
Very High $1207.50 $1437.50
O
ffice Use Only
Notes:
The applicant must be the person or entity that will take
a
ny money from the sale of alcohol.
Additional information may be requested during the
proce
ssing peri
od.
Applications take a minimum of 6-8 weeks to process.
Risk category: Fee: Payment received:
/ /
Public notices checked:
/ /
Initial:
Completed application
Prescribed fee
List of other clubs/organisations with which the club has reciprocal visiting rights for members
A menu with food descriptions and prices (or any other indication of the standard and style of food)
A beverage list showing beverage range and prices
Completed Building Evacuation Declaration (attached)
Copies of Managers’ Certificates
Copy of the Host Responsibility Policy
Public Notices (attached - to be checked before you place it in the newspaper and display it on the premises)
A4 or A3 to scale plan, clearly labeled, showing all of the following (for new application; renewal only if changes made to area):
The parts of the premises to be used for the sale or consumption of alcohol
The parts of the premises (if any) intended to be restricted, supervised or undesignated areas
The principal entrance
Map showing location of premises (new application)
Photo or artist’s impression of the premises (new application)
Certificate of Incorporation (new application)
Copy of the Club Charter, club rules or constitution (new application)
Completed Building Owner’s Approval (new application, attached)
Copies of Planning and Building certificates (new application)
Covering letter including any additional information relevant to this application (new application)
IF REQUIRED:
Security plan
Noise Management Plan (details noise sources and how they will be managed; may include
an acoustic report)
CPTED site assessment (attached)
Application
Club Licence or Renewal of Club Licence
Sale and Supply of Alcohol Act 2012
1 Application Details
b) Status of Applicant:
a) Full name(s) to be on licence (Exact club name, or your full legal name):
a) Application type (choose one):
New Club Licence (section 100)
Renewal of Club Licence (section 127(2))
Renewal of Club Licence with Variation (sections 120 and 127(2))
2 Applicant Details
To: The Secretary
District Licensing Committee
(Please tick one)
Carterton
Masterton
South Wairarapa
b) Variations to current licence conditions (if any):
(i
)
Which condition(s) do you want to vary (attach a separate page if necessary):
(ii) Full reasons why variation is sought (attach a separate page if necessary):
NCS No.
Incorporated society (sport or recreational
activity)
Other Body Corporate
Incorporated society (other)
2
3 Club Details
e) Is the club incorporated
Yes No
(i
)
Under which Act is the club incorporated?
If yes:
(ii
) Th
e date of incorporation
g) Main purpose of club:
Chartered
Sports
Other (specify)
f)
Status of club:
h) Total club membership: i) Number of members under 18:
j) Secretary’s name: k) Daytime telephone number (preferably the Secretary’s)
a) Address of club premises:
b) Trading name:
Yes No
c
) I
s the licence sought conditional on completing construction work?
If yes, please provide details:
d) Does the applicant own the proposed licensed premises?
Yes No
(ii
) W
hat form of tenure, and term of tenure, will the applicant have? (e.g. leasehold, tenancy)
(i
)
What is the full name of the owner?
If n
o attach a completed building owner’s approval form (page 7 of this form)
c) Postal address for service of documents:
d) Contact Details:
Name
Website
Preferred means of formal contact
Telephone
Mobile
Mail Email
Email
3
4 Managers’ Details
e) Does the club share the premises with any other club?
Yes No
(i) The name of the other club(s)
If yes:
(ii) The months of the year the other club(s) use the premises
No Yes
f)
Will the sale of alcohol be the principal purpose of the business?
If no, indicate what will be principal purpose of the business:
g) Which days and hours do you propose to sell or supply alcohol under the licence?
5 Conditions
a) Describe your experience and training in the sale and supply of alcohol:
Full Name Certificate Number Expiry Date Date of Birth
4
c) Describe to what extent and where drinking water will be freely available to patrons:
e) Describe the steps that will be taken to prevent the sale and supply of alcohol to minors and intoxicated people:
d) If there is no access to mains water supply, please comment on the potability of the water that will be available:
f) Describe what steps will be taken and what information will be provided to help with transport options from the licensed
premises:
b) Attach a menu and beverage list that describes food and beverage types, ranges and prices.
g) Describe what other steps will be taken to promote the responsible consumption of alcohol:
h) Describe any other systems (including training) and staff that are, or will be, in place to comply with the Act. Attach a copy of
y
our staff training plan/systems if applicable:
5
Applications must be submitted to the local council where the premises is located:
District Licensing Committee
Masterton District Council
PO Box 444
Masterton 5840
T 06 370 6300
E alcohol@mstn.govt.nz
www.mstn.govt.nz
District Licensing Committee
Carterton District Council
PO Box 9
Carterton 5743
T 06 379 4030
E health@cdc.govt.nz
www.cdc.govt.nz
District Licensing Committee
South Wairarapa District Council
PO Box 6
Martinborough 5741
T 06 306 9611
E health@swdc.govt.nz
www.swdc.govt.nz
NOTES:
1. The New Zealand Police are required by the Sale and Supply of Alcohol Act 2012 to make enquiries into the suitability of
the applicant. This will involve the Police informing the District Licensing Committee of any convictions or concerns involving
the applicant. Should there be any concerns, the applicant will also be informed.
2. This application, including personal information, will be available to the public and media as part of the District Licensing
Committee’s decision-making process.
3. This form must be accompanied by the prescribed fee.
4. The applicant must give public notice of this application (in Form 7) within 20 working days of filing with the District
Licensing Committee (10 days for a renewal). The notice must comply with regulation 36, 37 or 38 (whichever applies) of
the Sale and Supply of Alcohol Regulations 2013.
5. Except in the case of a conveyance, the applicant must ensure that notice of this application (in Form 7) is attached i
n a
cons
picuous place on or adjacent to the site to which this application relates, within 10 working days of filing with the
District Licensing Committee. The Secretary of the District Licensing Committee may waive this requirement if it is deemed
i
mpracticable or unreasonable to display the notice.
Da
ted this ________________ day of _____________ 20_______
Signature of Applicant ____________________________________
Club-Licence
6
Club Licence
Building Evacuation Declaration
Premises name
Premises address
I HEREBY STATE THAT
The owner of the building in which the premises are situated provides and maintains an evacuation scheme as required
by section 76 of the Fire and Emergency New Zealand Act 2017
OR
Because of the building’s current use, its owner is not required to provide and maintain such a scheme.
If you are unsure that the building has an approved evacuation scheme, check with the building owner.
For the requirements of an evacuation scheme. refer to Fire and Emergency New Zealand web site.
www.fireandemergency.nz/business-and-landlords
NOTE: Even if an approved evacuation scheme is not required, the building must have an evacuation procedure that meets
Part 1 of the Fire and Emergency New Zealand (Fire Safety, Evacuation Procedures, and Evacuation Schemes) Regulations 2018
this does not require approval by Fire Emergency New Zealand.
______________________________________
Building Owner’s Signature
______________________________________
Building Owner’s Name (print)
______________________________________
Date
______________________________________
Licensee Signature
______________________________________
Licensee Name (print)
______________________________________
Date
7
Club Licence
Building Owner’s Approval
______________________________________
Building Owner’s Signature
_
_____________________________________
Building Owner’s Name (print)
_
_____________________________________
Date
Premises name
Premises address
I HEREBY STATE THAT I have no objection to the Club-Licence being granted to
allow the sale and supply of alcohol from the above premises.
If the applicant is not the owner of the building, the owner must complete this form. Required for new applications.
8
Club Licence
CPTED Checklist for Club Licensed Premises
BAR AREA
Bar staff have good visibility of entire premises yes no n/a
Area behind the bar is raised to improve visibility yes no n/a
Bar area is open with no obstructions affecting monitoring of premises yes no n/a
Cash registers are front facing yes no n/a
If cash registers are not front facing, mirrors are installed to monitor customers yes no n/a
Safe is out of public view yes no n/a
INTERNAL LAYOUT
Premises is laid out so staff can monitor patrons at all times yes no n/a
There are no obstructions within the bar causing blind spots yes no n/a
Where there may be blind spots, mirrors or CCTV are installed yes no n/a
Bar is easily approached by customers yes no n/a
Customers can easily move around the premises yes no n/a
Sufficient seating is provided yes no n/a
Customers cannot climb on structures or fittings yes no n/a
CROWDING
There premises are not overcrowded yes no n/a
The maximum number of patrons for the premises is displayed and complied with yes no n/a
LIGHTING
Internal lighting is suitable yes no n/a
Lighting allows for door staff to check ID and similar yes no n/a
Lighting allows staff to monitor patrons within the premises yes no n/a
No areas are too dark inside the premises yes no n/a
Internal lighting can be raised in an emergency/incident or at closing time yes no n/a
External lighting is suitable yes no n/a
External security lighting is installed yes no n/a
VENTILATION
A ventilation system is installed yes no n/a
The premises are maintained at a suitable temperature yes no n/a
9
CPTED Checklist continued
OUTDOOR DRINKING AREAS
Outdoor drinking areas are monitored by bar and/or security staff yes no n/a
Lighting allows staff to monitor patrons yes no n/a
Customers can move around easily in outdoor drinking areas yes no n/a
Outdoor drinking areas are well defined from surrounding environment yes no n/a
Pavement creep is not evident yes no n/a
Outdoor drinking areas are not overcrowded yes no n/a
A current street trading licence or equivalent is held yes no n/a
CCTV
CCTV is installed yes no n/a
CCTV is positioned to monitor vulnerable areas yes no n/a
Patrons are aware of the CCTV system yes no n/a
Staff know how to operate the CCTV system yes no n/a
TOILETS
Toilet facility entrances are visible from the bar area yes no n/a
Toilets are inspected regularly yes no n/a
STAFF
There are sufficient numbers of staff to ensure control of the premises yes no n/a
Staff are visible to patrons yes no n/a
Staff monitor the premises for conflict and crime yes no n/a
Security staff are properly trained and certified yes no n/a
ENTRANCES AND EXITS
Entrances and exits are visible from behind the bar area yes no n/a
CCTV is installed to monitor blind entrances and exits yes no n/a
Door staff monitor entrances and exits yes no n/a
There is sufficient space for queuing outside the premises yes no n/a
10
To be placed in the Newspaper
First Second Only
This is the publication of this notice (date) __________________________
The first publication was on (date) ____________________________
Public Notice : Club Licence
Section 101 Sale and Supply of Alcohol Act 2012
This notice must be completed and attached to the Club Licence application so a Licensing Inspector can
check it before it is placed in a newspaper. It is the applicant’s responsibility to advertise this notice in either
the Wairarapa Times-Age or the Wairarapa News.
of a Club Licence in respect to the premises situated at (address):
for the
h
as made an application to the District Licensing Committee at:
Licensee Name
Address
Grant
Renewal
Known as (business name):
Th
e general nature of the business conducted / to be conducted under the licence is (e.g. golf club, rugby club):
Th
e days and hours during which alcohol is / is intended to be sold under the licence are:
Carterton District Council Masterton District Council South Wairarapa District Council
The application may be inspected during ordinary office hours of the relevant District Licensing Committee where the premises is located.
Any person who is entitled to object, and who wishes to object to the grant of the application, may, no later than 15 working days after the
date of the first publication of this notice, file their objection in writing with the Secretary of the relevant District Licensing Committee:
Masterton District Council
161 Queen Street, Masterton
PO Box 444
Masterton 5840
Carterton District Council
Holloway Street, Carterton
PO Box 9
Carterton 5743
South Wairarapa District Council
19 Kitchener Street, Martinborough
PO Box 6
Martinborough 5741
No objection to the issue of a licence may be made in relation to a matter other than a matter specified in section 105(1) of the Sale
and Supply of Alcohol Act 2012,
OR
No objection to the renewal of a licence may be made in relation to a matter other than a matter specified in section 131 of the Sale
and Supply of Alcohol Act 2012.
Renewal with variation
The following variation(s) to the conditions of licence are sought (if applicable):
11
To be displayed on the premises
Public Notice : Club Licence
Section 101 Sale and Supply of Alcohol Act 2012
This notice must be completed and attached to the Club Licence application so a Licensing Inspector can
check it before it is displayed on the premises.
of an Club Licence in respect to the premises situated at (address):
for the
Grant
Renewal
Known as (business name):
Th
e general nature of the business conducted / to be conducted under the licence is (e.g. golf club, rugby club):
h
as made an application to the District Licensing Committee at:
Address
Carterton District Council Masterton District Council South Wairarapa District Council
No objection to the issue of a licence may be made in relation to a matter other than a matter specified in section 105(1) of the Sale
and Supply of Alcohol Act 2012,
OR
No objection to the renewal of a licence may be made in relation to a matter other than a matter specified in section 131 of the Sale
and Supply of Alcohol Act 2012.
Renewal with variation
The days and hours during which alcohol is / is intended to be sold under the licence are:
The application may be inspected during ordinary office hours of the relevant District Licensing Committee where the premises is located.
Any person who is entitled to object, and who wishes to object to the grant of the application, may, no later than 15 working days after the
date of the first publication of this notice, file their objection in writing with the Secretary of the relevant District Licensing Committee:
Masterton District Council
161 Queen Street, Masterton
PO Box 444
Masterton 5840
Carterton District Council
Holloway Street, Carterton
PO Box 9
Carterton 5743
South Wairarapa District Council
19 Kitchener Street, Martinborough
PO Box 6
Martinborough 5741
The following variation(s) to the conditions of licence are sought (if applicable):
Licensee Name
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