Checklist
Variation or Cancellation of Conditions
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
Applications 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.
Fee category Application fee
Very low $368
Low $609.50
Medium $816.50
High $1023.50
Very High $1207.50
O
ffice Use Only
Risk category: Fee: Payment received:
/ /
Public notices checked:
/ /
Initial:
Completed application form
The prescribed fee
Public Notices (attached - to be checked before you place it in the newspaper and display it on the premises)
The applicant must be the person or entity that will take any money from the sale of alcohol.
Additional information may be requested during the processing period.
Applications take a minimum of 6-8 weeks to process.
1
Application
Variation or Cancellation of Conditions
Sale and Supply of Alcohol Act 2012
To: The Secretary
District Licensing Committee
(Please tick one)
Carterton
Masterton
South Wairarapa
NCS No.
1 Licensee Details
Full Name
Telephone
Email
Postal address
Mobile
2 Licence Details
Type of licence
On-licence / number ____________________________
Off-licence / number ____________________________
Club licence / number ___________________________
(not a conveyance)
3 Premises Details
Trading (or other) Name
Address
4 Conveyance Details
Trading (or other) Name
Home base address
Type of conveyance (bus, ship etc.)
2
5 Conditions and Requested Actions
a) Current condition to be changed:
How do you want to vary the condition?
Action sought:
Cancellation Variation
Full reasons for the cancellation or variation:
Fill in a section for each condition the application relates to (attach a separate sheet if necessary):
b
) Cu
rrent condition to be changed:
How do you want to vary the condition?
Action sought:
Cancellation Variation
Full reasons for the cancellation or variation:
3
Da
ted this ________________ day of _____________ 20_______
Signature of Applicant ____________________________________
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.
Variation or Cancellation of Conditions
4
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 : Variation or Cancellation of Conditions
Section 101 Sale and Supply of Alcohol Act 2012
This notice must be completed and attached to the 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 an On-Licence / Off-licence / Club licence (circle one) in respect to the premises situated at (address):
for the
has made an application to the District Licensing Committee at:
Licensee Name
Address
Or in respect to a conveyance (e.g. bus, train):
Known as (business name):
The g
eneral nature of the business conducted / to be conducted under the licence is (e.g. hotel, tavern, restaurant, nightclub):
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 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.
Cancellation of conditions
The following variation(s) to the conditions of licence are sought (if applicable):
Variation of conditions
5
First Second Only
This is the publication of this notice (date) __________________________
The first publication was on (date) ____________________________
Public Notice : Variation or Cancellation of Conditions
Section 101 Sale and Supply of Alcohol Act 2012
of an On-Licence / Off-licence / Club licence (circle one) in respect to the premises situated at (address):
for the
has made an application to the District Licensing Committee at:
Licensee Name
Address
Or in respect to a conveyance (e.g. bus, train):
Known as (business name):
The g
eneral nature of the business conducted / to be conducted under the licence is (e.g. hotel, tavern, restaurant, nightclub):
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:
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.
Cancellation of conditions
The following variation(s) to the conditions of licence are sought (if applicable):
Variation of conditions
To be displayed on the premises
This notice must be completed and attached to the Licence application so a Licensing Inspector can check it
before it is displayed on the premises.
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
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome