Application for registration as a wholesaler of liquor

Application for the Grant as a Wholesaler of Liquor /
1. Notes to application
1.  / Application for registration as a wholesaler completed and signed by the applicant (form attached)
2.  / Licence duration: 1 year $20* 3 years $60* 5 years $100*
3.  / Certificate of Incorporation and Company Extract if applicant is a Company.
4.  / Business Names Certificate of Registration and Business Names Extract.
5.  / Copy of Partnership agreement if applicant is a partnership.
6.  / Any partnership agreement should contain a clause nominating the majority shareholder as Licensee. Where minor or equal shareholder is nominated there shall be inserted in the agreement a clause which prevents the other partners from unjustly vetoing the person nominated as Licensee from complying with a lawful direction pursuant to the Liquor Act or any other law or regulation governing in any way the sale of liquor.
7.  / Authority to release criminal history fingerprint.
An authority is to be completed by each company director or partner in the case of a partnership. Also any person who holds more than a 15% interest in the company.
The applicant, in completing this form should declare even minor traffic offences or misdemeanours to prevent what may appear to be a deliberate attempt to mislead the Director-General of Licensing in determining suitability for appointment.
8.  / Personal profile (resume) and two written business references for each Company Director or Partner, in the case of a partnership.
9.  / Proof of financial capacity to conduct the business of this licence application. This is usually in the form of a list of assets/liabilities (financial statements) of the company/individual, preferably with an appropriate letter from the Applicant’s Bank and/or Accountant addressing the question of the Applicant’s financial stability.
10.  / Company search, including details of all directors and shareholders, holding companies or any associated company (and includes details of all directors and shareholders of this company) or partnership. In the case of shareholders being a company, ASIC details for that company.
11.  / An inspection of the premises conducted by an Inspector of licensed premises.
12.  / Submit all applications to Territory Business Centre
(see section 4 for lodgement options).
2. Application details
Name of Premises
Address of Premises
Postal Address for future correspondence
Full name of Proposed Licensee
Phone / Facsimile
Mobile / Email
If Proposed Licensee is a corporate body, list full name of contact person.
Propose to be agents for:
Names and types of liquor proposed to be carried
Beer / Wine / Spirits / Other
I/We apply for approval for the grant of a Wholesale Liquor Licence in accordance with the information provided above/in the attached statement.
I/We understand that a return is required quarterly showing all purchases and sales of liquor pursuant to section 114(1) of the Liquor Act.
I/Weunderstand non-compliance with the reporting requirements under section 114(1) of the Liquor Act is an offence of strict liability and subject to infringement notice penalties pursuant to section 114(2) of the Liquor Act and Schedule 2 part 2 of the Liquor Regulations, respectively.
Signature of Proposed Licensee / Date
Print name and title
Company Questionnaire
Name of Premises
Address of Premises
Company Name( to be shown as Licensee)
Business Trading Name
ACN
Address
Details of Company Directors, Shareholders, Partners (including silent partners), Office holders (Clubs) , or any other person having an influence in the conduct of the premises
Surname / Given Name(s) / Place of Birth / Date of Birth / Status (e.g) Partner/Director)
3. Notice In Accordance with the Information Act
(Information Privacy Principle 1)
Licensing NT is seeking information from you for the purposes of your application.
Information Privacy Principle 1 (IPP 1) requires that a public sector organisation must not collect personal information unless the information is necessary for one or more of its functions or activities. If personal information about an individual is collected from the individual, the organisation must take reasonable steps to ensure that the individual is aware of certain matters. For the purposes of IPP 1, the following advice is provided.
a)  You are able to access your personal information that you have provided by making a written request to the Director-General of Licensing.
b)  The information is required pursuant to the Liquor Act. The Act requires that certain matters must be considered when deciding whether or not to approve an application.
c)  The information will be kept confidential except as follows:
i.  Information may be sought from Police, government agencies, interstate licensing authorities, or referees or other persons nominated by you. Information may be released to those sources to the extent necessary to verify information about you and your application.
ii.  Registers of licences and permits will be maintained and may be made available to the public on request.
d)  You do not have to provide information if you do not wish to do so. However, an application may not be approved if there is insufficient information to properly determine the matter in accordance with the Act.
4. Lodgement options
Once this application is completed it must be lodged at a Territory Business Centre (TBC) with the prescribed fee at:
Darwin
Building 3,
Darwin Corporate Park,
631 Stuart Highway,
Berrimah
GPO Box 9800
Darwin NT 0801
t: (08) 8982 1700
f: (08) 8982 1725
Toll free: 1800 193 111
e: / Katherine
Shop 1, Randazzo Building
18 Katherine Terrace
Katherine
PO Box 9800
Katherine NT 0851
t: (08) 8973 8180
f: (08) 8973 8188
e:
Tennant Creek
Shop 2, Barkley House
Cnr Davidson and Paterson Street
Tennant Creek
PO Box 9800
Tennant Creek NT 0861
t: (08) 8962 4411
f: (08) 8982 1725
e: / Alice Springs
Ground Floor, The Green Well Building
50 Bath Street
Alice Springs
PO Box 9800
Alice Springs NT 0871
t: (08) 8951 8524
f: (08) 8951 8533
e:
5. Fees and payment
*Contact your local TBC for the relevant schedule of fees and payment options
Please refer to the relevant schedule of fees http//www.nt.gov.au/gls
Cash - Territory Business Centre
Cheque - payable to RTM (Receiver to Territory Money)
Credit card / Visa MasterCard
Credit Card number
Expiry
Name on card
I hereby authorise the Territory Business Centre to debit the above credit card for the amount of / $
Amount in words / dollars
Signature of cardholder / Date
Contact phone number

Department of Attorney-General and Justice