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How to apply for a new
Manager’s Certificate
Under Section 219 of the Sale and Supply of Alcohol Act 2012
Follow the instructions below to apply for a manager’s certificate which authorises the
holder to manager any licensed premises.
Check you qualify to apply first
To hold a manager’s certificate you must:
be 20 years or older
have a Licence Controller Qualification (LCQ) certificate
be working or intend to be working in a licensed premises
have at least 6 months experience supervising licensed premises in New Zealand
What you need to do next
To apply for a new manager’s certificate, you need to:
supply the documents listed in the ‘What to include’ section on this page
pay the application fee of $316.25
answer all the questions in the form that apply to you
attend an interview with an alcohol licensing inspector (after we receive your form, we
will contact you to arrange a time)
How to submit your application
Choose any one of the following ways to submit your application:
Email application to alcohol@goredc.govt.nz
Drop off your application at 29 Bowler Avenue, Gore 9710
Post your application to PO Box 8, Gore 9740
How to get LCQ certification
If you don’t have an LCQ certificate
Find out how to get an LCQ certificate at serviceiq.org.nz/lcq/license-controller-qualification
If you have an LCQ certificate, check it is up to date
If your LCQ certificate stated ‘Sale and Supply of Alcohol Act 2012’ on it, your certificate is
up to date.
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What to include
You must supply all the documents listed below. We will send your application back if any
of these are missing.
The complete application form
A copy of your photo identification
A copy of your LCQ certificate
A letter from your employer or club, confirming that you are or will be employed there
Two references, one industry related and one character reference
Paying your fee
You must pay the fee of $316.25 (including GST). This fee is not refundable or transferable.
Payment options
By mail
Send your cheque and the application form to:
Gore District Council
PO Box 8
Gore 9740
In person
You can pay by cash, cheque, eftpos or credit card (credit card payments incur a surcharge)
Gore District Council
29 Bowler Avenue
Gore 9710
Electronic banking
Bank account 03 0915 0289519 00 using reference MC followed by your name
Email your application and supporting documentation to:
alcohol@goredc.govt.nz
Form 19
Application for renewal of
Manager’s Certificate
Section 224, Sale and Supply of Alcohol Act 2012
To: The Secretary
District Licensing Committee
Gore District Council
PO Box 8
Gore 9710
03 209 0330
Application for the renewal of a managers certificate is made in accordance with the details set
out below:
Details of applicant
Male Female
Full legal name:
Preferred name:
Maiden / previous name or any alias:
Usual address:
Date of birth:
Place of birth:
Contact number:
Mobile number:
Email address:
Do you have any convictions? Yes No
If yes, please give details:
Current place of employment:
Details of position you hold:
Name of licensed premises you are working at:
How long have you worked at this premises?
Office Use Only
Area Office Stamp
Application forwarded to:
Police Response received Y N
Inspector Response received Y N
Payment:
Cash Chq Eftpos DD CtCd
Paid by: Applicant Other __________
Date Paid:
Receipt Number:
Work visa status: Yes No N/A
If yes, you must supply a copy of your visa with this application.
Certificate Number:
Expiry Date:
What Council issued your previous certificate?
Do you hold the Licence Controller Qualification or a prescribed qualification within the meaning
of section 218 of the Sale and Supply of Alcohol Act 2012? Yes
No
If yes, on what date was the qualification obtained?
If you obtained your LCQ before 18 December 2013, have you completed the LCQ Bridging
Course? Yes
No
If yes, on what date was this completed?
What steps do you intent to take to manage the sale and supply of alcohol pursuant to the licence
with the aim of contributing to the reduction of alcohol-related harm?
Signature of Applicant:
Date:
Please attach the following:
Licence Controller Qualification (LCQ) and any Bridging Test certificate if appropriate.
If applicable, copy of Visa.
Overseas residents seeking work in New Zealand should provide a copy of their passport details.
The fee of $316.25.
A copy of your photo identification.
A letter from your employer or club, confirming you are or will be employed there.
A copy of your existing manager’s certificate.
click to sign
signature
click to edit
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