Fillable Section 231, Sale and Supply of Alcohol Act

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Section 231, Sale and Supply of Alcohol Act

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Name of licensed premises:
Licensee
:
Licence number:
Address of Licensed Premises:
Contact Phone: Email :
What are you notifying? (Please tick and complete the application)
New Certificate Holding Manager
Full Name: Effective from: / /
Certificate Number: Expiry Date:
Temporary Manager
Effective from: / /
Full Name: Date of Birth:
Residential
Address:
Certificate Number
Expiry Date:
Who they
are replacing:
Reason:
Note that a temporary manager must apply for a manager’s certificate within two working days of their appointment.
Acting Manager
Effective from: / /
Full Name: Date of Birth:
Residential
Address:
Certificate
Number: Expiry Date:
Who they
are replacing:
Reason:
Termination/Cancellation of Manager Applicant
Full Name: Effective from: / /
Certificate Number: Expiry Date:
Forward a copy of this form, within two working days of the appointment (or termination,) to:
The Secretary
Upper Hutt District Licensing
Committee Upper
Hutt City
Council
Private Bag
907
UPPER HUTT
5140
Email:
alcohol@uhcc.govt.nz
New Zealand Police
Email: AHPO.Wellington@police.govt.nz
Signature of licensee: Date:
Name:
Position:
Notice of Management Change
Section 231, Sale and Supply of Alcohol Act 2012
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Section 231, Sale and Supply of Alcohol Act

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Completed 26 August 2021

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