Fillable Information sheet new or renewal of off-licence (Napier City Council New Zealand)

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Information sheet new or renewal of off-licence (Napier City Council New Zealand)

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Receipt amount:
Application Name:
OFF
Form 4 Application for new or renewal of off-licence Page 1 of 14
Information sheet –
new or renewal of off-licence
To complete the application you will need to answer all questions, supply all requested documentation and attach the
prescribed fee(s). Please ensure you attach this information sheet when lodging your application.
What to include (please tick)
The original application form plus one copy.
The correct application fee.
The correct annual fee. (new applications only)
Building & Planning certificates for the purpose of s.100 (f) of the Act. (new applications only)
If the applicant is not the owner of the premises or conveyance, written consent from the owner to the effect that the
owner has no objection to a licence being granted. (new applications only)
A copy of all menus, food and drinks. (new applications only)
A copy of the Certificate of Incorporation (new applications only, if applicable).
Good quality scale plans of the premises or conveyance that clearly demonstrate the following: (new applications only)
The design and layout of the premises,
The principle entrance,
Any designated areas - clearly highlighted,
Any proposed permitted area for the display and promotion of alcohol, and any proposed sub-areas.
A photo of the exterior of the premises showing the principal entrance. (new applications only)
Where it must be determined whether the premises are a grocery store, the statement of annual sales revenue
required by regulation 12 or 13 of the Sale and Supply of Alcohol Regulations 2013. (new applications only)
If you are using an alcohol licensing consultant, a letter authorising your consultant to act on your behalf.
When you have all the required documentation, you can lodge your application. Failure to supply all required documents will
result in the application being returned.
Your application must be accompanied by the correct application fee. This is not refundable.
Use the fee calculator overleaf to calculate your risk rating and then tick the appropriate box from the table below. All
applications must be accompanied by the correct application fee. New applications must also be accompanied by the correct
annual fee. Renewal applications do not require an annual fee, this will be invoiced on a date determined by the Napier
District Licensing Committee.
Please ensure you have accurately assessed your fee. Any errors will incur a further application payment and your licence will
not be issued until all outstanding monies are received.
Risk category (risk weighting)
Application/Renewal Fee (inc GST)
Annual Fee (inc GST)
Very low (0-2)
$368.00
Low (3-5)
$609.50
Medium (6-15)
$816.50
High (16-25)
$1,023.50
Very high (26 plus)
$1,207.50
If you require assistance calculating your risk rating, please contact the Licensing Inspector on 06 834 4145.
Form 4 Application for new or renewal of off-licence Page 2 of 14
Fee Calculator - new or renewal of off-licence
Step 1 – Identify your premises type weighting
Step 2 – Identify your trading hours weighting
H
Trading hours
Latest trading time authorised by licence
Weighting
10.00 pm or earlier
0
Your weighting
10.01 pm or later
3
Remote sale premises
0
Information – Trading hours
For new applications, select the weighting that corresponds with the trading hours you are applying for.
For renewals with no variation sought, select the weighting that corresponds with the trading hours currently described
on your licence.
For renewals with variation sought, select the weighting that corresponds with the proposed trading hours that you are
seeking through the variation.
Step 3 – Identify your enforcement/holdings weighting
E
Enforcement
Number of Holdings in last 18 months
Weighting
None
0
Your weighting
1
10
2 or more
20
Information – Holdings
A holding is a conviction for any offence prescribed within section 288 of the Sale and Supply of Alcohol Act 2012, or a
conviction for any equivalent offence under the Sale of Liquor Act 1989.
Step 4 – Calculate your risk rating
P
+
H
+
E
=
Risk rating
+
+
=
Return to the fees table on page 1 and tick the box that corresponds with your risk rating.
Lodgment Options
You can post your completed application form with cheque to:
Napier City Council, Private Bag 6010, Napier 4142.
You can lodge your application in person with cash, cheque or Eftpos at
Napier City Council, 231 Hastings Street, Napier.
P
Premises type
Type of premises
Weighting
Supermarket, grocery store, bottle store
15
Your weighting
Off-licence within a hotel or tavern
10
Remote sale premises and premises not otherwise specified
5
Winery cellar door
2
Form 4 Application for new or renewal of off-licence Page 3 of 14
Application form –
New or renewal of off-licence
Sections 100 and 127(2), Sale and Supply of Alcohol Act 2012
The application
To the Secretary, Napier District Licensing Committee:
Application for:
A new off-licence is made in accordance with the details below, or
Renewal of an off-licence under the same conditions is made in accordance with the details below, or
Renewal of an off-licence with changes sought to the existing conditions is made in accordance with the details below.
If any changes are sought to the existing conditions of an off-licence, describe every change sought:
Endorsements
Tick the endorsement, if any, that is sought, or sought to be renewed:
Section 39, Auctioneer,
Section 40, Remote sales only.
The applicant
Company name or full legal name(s) of persons to be on licence:
Existing licence(s)
Is a licence of any type of already held for the premises or conveyance concerned?
Yes
No
If Yes, provide the details of the licence or licences:
Status of the applicant (tick appropriate option)
Natural person
Private Company
Partnership
Local Authority
Public Company
Licensing Trust
Trustee
Board, organisation or other body to which section 28 (1) (c) of the Act applies
Manager under the Protection of Personal and Property Rights Act 1988
Body Corporate to which section (28 (1) (b) of the Act applies
Government department or other instrument of the Crown
Form 4 Application for new or renewal of off-licence Page 4 of 14
Applicant details (natural persons only)
For an applicant that is a natural person or persons, provide the following details for each applicant:
Full legal name of the applicant:
Any aliases used by the applicant:
Full residential address:
Postcode:
Email address:
Male
Female
Occupation:
Date of birth:
Place of birth:
Daytime contact name and telephone number:
Preferred mode of contact:
If any additional applicants exist, provide their details as a separate attachment.
Tick this box if further applicant details have been supplied as a separate attachment.
Applicant details (applicants other than natural persons)
For all applicants other than natural persons, provide the following details:
Name of contact person:
Daytime phone number:
Mobile phone number:
Fax number:
Email address:
Preferred mode of contact:
Postal address for service of documents
Building name (if any):
Street number:
Street name:
Suburb:
:
City:
Postcode:
Business details
Describe the principle business, or any other business conducted by the applicant:
Criminal convictions:
Has the applicant been convicted of any criminal convictions?
Yes
No
If Yes, provide details including dates of convictions and penalties imposed.
* State all criminal convictions (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)]
Form 4 Application for new or renewal of off-licence Page 5 of 14
Further details where the applicant is a Body Corporate
For an applicant that is a body corporate, under which authority is the body incorporated?
Further details where applicant is a company
For an applicant that is a company (whether incorporated under the Companies Act 1993, or equivalent foreign legislation),
provide the full legal name of every director:
Further details where applicant is a partnership
For an applicant that is a partnership, provide the following details:
Partner 1 full legal name:
Partner 1 address:
Postcode:
Partner 1 date of birth:
Partner 1 place of birth:
Signature of partner 1.
Partner 2 full legal name:
Partner 2 address:
Postcode:
Partner 2 date of birth:
Partner 2 place of birth:
Signature of partner 2.
If any additional partners exist, provide their details as a separate attachment.
Tick this box if further partner details have been supplied as a separate attachment.
Further details where applicant is a public company
For an applicant that is a public company, provide the full details of each person who holds 20% or more of the shares, or of
any particular class of shares, issued by the company.
Full legal name of shareholder:
Address of shareholder:
Postcode:
Date of birth:
Place of birth:
Designation:
Full legal name of shareholder:
Address of shareholder:
Postcode:
Date of birth:
Place of birth:
Designation:
If any additional public shareholders exist, provide their details as a separate attachment.
Tick this box if further public shareholder details have been supplied as a separate attachment.
Form 4 Application for new or renewal of off-licence Page 6 of 14
Further details where applicant is a private company
For an applicant that is a company incorporated under the Companies Act 1993, provide the following details:
Authorised capital:
Paid up capital:
Shareholder details
Full legal name of shareholder:
Address of shareholder:
Postcode:
Date of birth:
Place of birth:
Designation:
Face value of shares held:
Full legal name of shareholder:
Address of shareholder:
Postcode:
Date of birth:
Place of birth:
Designation:
Face value of shares held:
If any additional private shareholders exist, provide their details as a separate attachment.
Tick this box if further private shareholders details have been supplied as a separate attachment.
Premises details
Legal address:
Postcode:
Any name, trading name or name of building:
Does the applicant own the premises?
Yes
No
If No, what is the full legal name and address of the owner:
What form of tenure will the applicant have (including term of tenure)?
Is a licence conditional upon construction or completion of building work?
Yes
No
If Yes, provide details:
Fire safety declaration
For an application that is made in respect of premises, the applicant must confirm that—
The owner of the building in which the premises are situated provides and maintains an evacuation scheme as
required by s.21B of the Fire Service Act 1975; or
Because of the building's current use, its owner is not required to provide and maintain such a scheme; or
Because of the nature of the building, its owner is exempt from the requirement to provide and maintain such a
scheme.
Form 4 Application for new or renewal of off-licence Page 7 of 14
Management
Provide the following details in respect of each manager or proposed manager:
Full legal name:
Certificate number:
Certificate expiry date:
Full legal name:
Certificate number:
Certificate expiry date:
Full legal name:
Certificate number:
Certificate expiry date:
Full legal name:
Certificate number:
Certificate expiry date:
If any additional managers are to be employed, provide their details as a separate attachment.
Tick this box if further manager’s details have been supplied as a separate attachment.
Business details
Is the sale of alcohol intended to be the principle purpose of the licence?
Yes
No
If No, what is intended to be the principle purpose of the business?
Is the applicant engaged, or intending to be engaged, in the sale or supply of any goods other than alcohol and food, or in
the provision of any services other than those directly related to the sale or supply of alcohol and food?
Yes
No If Yes, what is the nature of those other goods or services?
Proposed trading hours
Describe the trading hours proposed for the sale of alcohol:
Type of licence sought:
State the type of licence sought (grocery, hotel, supermarket etc.):
Form 4 Application for new or renewal of off-licence Page 8 of 14
Conditions
Prohibited persons
What steps does the applicant propose to take to ensure that the requirements of the Act in relation to the sale of alcohol to
prohibited persons are observed?
Other steps to be taken
What other steps does the applicant propose to take aimed at promoting the responsible consumption of alcohol?
Other systems in place
What systems (including staff training) and staff are in place (or to be in place) for compliance with the Act?
Applicants experience
Describe any relevant experience or training of the applicant:
Form 4 Application for new or renewal of off-licence Page 9 of 14
Amenity and Good Order
Nuisance and vandalism
Are there any current levels of nuisance or vandalism affecting the locality, and could granting the application exacerbate or
introduce the level of nuisance or vandalism? If so, what plan does the applicant have to reduce the level of nuisance or
vandalism?
Other licensed premises
What other licensed premises are there in the vicinity of the premises? And, will the granting of this licence contribute to an
increase in alcohol related problems in the area? (Explain)
Neighboring land use
What is the land near the proposed premises being used for? Will the granting of a licence for your premises impact on
changing neighboring land use? If so, in what way
Form 4 Application for new or renewal of off-licence Page 10 of 14
Attachments
Tick this box to confirm that you have read page 1 and have provided all of the items listed.
Notes:
Signed at
(place):………………………..…………..…….
On
(date):……..………..…………………………………………..
Applicant name
:…………………………………….……..
Applicant signature
:……..……………………………………...
Form 4 Application for new or renewal of off-licence Page 11 of 14
Public notices - new or renewal of off-licence
Within 10 working days of lodging a renewal application or 20 working days for new applications, a notice of the application
(form 7) must be placed in the Napier Mail or the Hawkes Bay Today. The renewal of very-low and low risk premises requires
the placement of only one notice. For all other applications, notices must be placed twice in the same paper, not more than
10 working days apart. This is known as the ―news-paper notice‖.
Within 20 working days of lodging any application, a notice of the application (form 7) must be attached in a conspicuous
place on or adjacent to the site to which this application relates for a period of not less than 10 days. This is known as the
―site notice‖.
Public Notice – Site Notice
The correct form of the notice to be displayed on or adjacent to the premises is as follows:
Form 7
Public notice of application for on-licence, off-licence, or club licence
(or application for variation of conditions of on-licence, off-licence, or club licence)
Section 101, Sale and Supply of Alcohol Act 2012
Full name of the licence holder:
Address:
Occupation:
Has made application to the District Licensing Committee at Napier for the (issue or renewal or variation of conditions) of a:
(state kind of licence)
In respect of premises situated at: (or the [specify kind of conveyance] known as)
The general nature of the business conducted (or to be conducted) under the licence is: (type of business, e.g. hotel, tavern,
restaurant, entertainment/night club)
The days on which and the hours during which alcohol (is or is intended to be) sold under the licence are: (specify days and
hours)
The application may be inspected during ordinary office hours at the office of the Napier District Licensing Committee at: 231
Hastings Street, Napier South, Napier.
Any person who is entitled to object and who wishes to object to the issue of the licence may, not later than 15 working days
after the date of the publication of this notice, file a notice in writing of the objection with the Secretary of the District
Licensing Committee at: Private Bag 6010, Napier 4142.
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.
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.
Form 4 Application for new or renewal of off-licence Page 12 of 14
Public Notice – Newspaper Notice
The correct form of the notice to be displayed within the Hawkes Bay Today or Napier Mail is as follows:
Form 7
Public notice of application for on-licence, off-licence, or club licence
(or application for variation of conditions of on-licence, off-licence, or club licence)
Section 101, Sale and Supply of Alcohol Act 2012
Full name of the licence holder:
Address:
Occupation:
Has made application to the District Licensing Committee at Napier for the (issue or renewal or variation of conditions) of a:
(state kind of licence)
In respect of premises situated at: (or the [specify kind of conveyance] known as)
The general nature of the business conducted (or to be conducted) under the licence is: (type of business, e.g. hotel, tavern,
restaurant, entertainment/night club)
The days on which and the hours during which alcohol (is or is intended to be) sold under the licence are: (specify days and
hours)
The application may be inspected during ordinary office hours at the office of the Napier District Licensing Committee at: 231
Hastings Street, Napier South, Napier.
Any person who is entitled to object and who wishes to object to the issue of the licence may, not later than 15 working days
after the date of the publication of this notice, file a notice in writing of the objection with the Secretary of the District
Licensing Committee at: Private Bag 6010, Napier 4142.
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.
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.
This is the [state whether first, second, or only] publication of this notice:
This notice was first published on:[state date].
Form 4 Application for new or renewal of off-licence Page 13 of 14
Additional information
Form 4 Application for new or renewal of off-licence Page 14 of 14
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Information sheet new or renewal of off-licence (Napier City Council New Zealand)

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Completed 21 January 2021

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