Application for a Smoking Product Licence (New)

Application for a Smoking Product Licence (New)

Use this form to apply for a licence to sell tobacco products or personal vaporiser
products (including e-cigarettes) in Tasmania. A separate form is used to
apply to renew an existing licence.

Select the type of smoking product licence you are applying for:

A new licence to sell tobacco products only (not personal vaporiser products) code 683

A new licence to sell tobacco products and personal vaporiser products code 683

A new licence to sell personal vaporiser products only (not tobacco products) code 691

If you currently hold a licence to sell tobacco products, insert your licence number here ______ (notification only no fee)

Please provide the following details

Applicant’s Details (Only an individual aged 18 years or over can apply for a licence.
Companies, partnerships, or other groups cannot apply.)
Title:
Given Names:
Surname:
Email:
Home Address:
Postcode:
Business Address:
Postcode:
Home Phone: / Mobile Phone:
Date of Birth: / Day / Month / Year / Proof of age must be attached to this application. Acceptable forms of proof of age are listed at the end of this form.
Premise Details (details of premise where smoking products are to be sold from)
Business Name:
Address of premises
Postcode:
Opening hours:
Business Phone:
Type of Premises (please tick one option from list below)
q Bar/pub/club / q Bottleshop / q Restaurant/cafe / q Takeaway shop
q Newsagency / q Specialist tobacconist / q Mixed business / q Service station
q Small supermarket (ie IGA/Festival) / q Large supermarket (ie Woolworths/Coles) / q Electronic dispensing Machine or Vending machine / q Vape Shop
q Other (please describe)

Fit and Proper Checks

In assessing this application, the Director of Public Health (or delegate) is to consider whether the applicant is a fit and proper person to hold a smoking product licence.

In assessing this, the Director may make enquiries with agencies in other States and Territories that regulate laws for smoking or poisons related matters. When this occurs, the Director will release details of the applicant and the application to those agencies.

The Director may also ask police (across Australia) for a report of convictions and proceedings taken against the applicant. The Director cannot ask for this report without the applicant’s consent / agreement. The applicant may refuse consent. If consent is not given, the Director may refuse to determine the application.

Do you authorise the Director to obtain police reports of convictions and proceedings taken against you?

YES / NO (please circle)

Please tick any of the following statements that are true

In the last five years:

In the past five years, I have been refused a licence to sell tobacco products or electronic cigarettes (anywhere in Australia)

In the past five years, I have held a licence to sell tobacco products or electronic cigarettes (anywhere in Australia)

In the past five years, I have had a licence to sell tobacco products or electronic cigarettes cancelled

I am currently involved in legal proceedings, or in the past five years I have been found guilty or received an infringement notice (which is an on-the-spot fine), for failing to follow any of the following laws that applied to me:

·  licensing or retailer laws (any state or territory)

·  laws for retailers (any state or territory)

·  poisons laws (such as those for nicotine)

·  the Commonwealth Tobacco Advertising Prohibition Act 1992

·  the Commonwealth Tobacco Plain Packaging Act 2011

·  an offence under Customs Act 1901 or the Excise Act 1901

Declaration

Please note it is an offence under the Public Health Act to make a statement that you know is false or misleading.

I declare that the information provided by me in this application is true and correct.

______

Signature Date

Acceptable Forms of Proof of Age

·  Australian Driver Licence

·  Tasmanian Government Personal Information Card

·  Australian Passport

·  Overseas Passport

·  Australian Citizenship papers

·  Firearm licence

·  Birth certificate

Current Fees

A licence to sell tobacco products only (not personal vaporiser products) Code 683

A licence to sell both tobacco products and personal vaporiser products Code 683

A licence to sell personal vaporiser products only (not tobacco products) Code 691

If you currently hold a licence to sell tobacco products and are applying Notification only

to sell personal vaporiser products

This application is made under the Public Health Act 1997. The Act helps to protect the health of all Tasmanians and includes laws that apply to the sale of smoking products (tobacco products and personal vaporiser products) in Tasmania. Retailers should become familiar with their obligations under the Act and mandatory guidelines issued by the Director of Public Health. The Act is available at www.legislation.tas.gov.au and the Guidelines are available at www.dhhs.tas.gov.au/publichealth/tobacco_control. The Department’s website also has a guide for retailers.

Application Checklist

  Completed all the questions for your application to be processed. All questions must be answered or your application will not be processed.

  Application is for an individual aged 18 years or over not in a company, partnership, or other group name.

  Provided photographic identification which proves you are aged 18 years or over.

  If you intend to sell tobacco products or personal vaporiser products at more than one premise, you have completed an application form and paid the application fee for each premise.

  Lodged your completed application form and fee in person at any Service Tasmania shop.

You will be contacted by the Department when your application has been assessed.

Please call the tobacco licensing officer on (03) 6166 6665 if you have any questions about applying for a licence.

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