What is the liquor licence number (it starts with the letters “LIQ”)
Is the Existing Licensee available to sign the declaration consenting to the transfer?
Will the Licence be transferred to:
Please write the full name of the Proposed Licensee below [i.e. the individual’s full name or the company’s registered name]
Is the abovenamed individual or company the holder of another liquor licence [i.e. as licensee]?
Full Name
First Name
Last Name
Gender
*
Residential Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Postal Address, if different to the above
Date of Birth
MM
DD
YYYY
Place of Birth
Mobile Number
Email Address
If you have a NSW Competency Card, please write the number below [It starts with the letters "CCH"].
Investigations, prosecutions, or official warnings
Have you (or the company, if it will be the proposed Licensee) ever been the subject matter of an investigation, prosecution, official warning issued by the NSW Police, or been refused, suspended or disqualified from holding a liquor licence or gaming licence in Australia, or been the subject matter of any disciplinary action under the liquor and gaming laws anywhere in Australia?
The full name of the company
ABN or ACN
Business Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Postal address (if different to the above)
Email address
ASIC extract
The NSWL&G will require an ASIC extract of the Company, showing its directors, secretary and shareholders. Tick “yes” if we are authorised to obtain this extract on your behalf. If you tick “no” you must provide this extract to us.
The Approved Manager
In NSW an Approved Manager is required when a liquor licence is held by a company. Have you identified this individual?
Other interested parties
Is there any other party interested in the business of the Licence? An “interested party” is any person or entity that is interested in the business, or the profits of the business, carried on under the Licence if that person or entity is entitled to receive:
• any income derived from the business, or any other financial benefit or financial advantage from the carrying on of the business (whether the entitlement arises at law or in equity or otherwise), or
• any rent, profit or other income in connection with the use or occupation of premises on which the business is to be carried on.
Lodgement fee payable to L&GNSW
The lodgement fee will vary depening on the type of liquor licence being transferred. For example:-
• a hotel or packaged liquor licence is $875,
• a limited licence is $125, and
• any other type of licence is $500.
This amount must be paid by the use of a credit card. Please provide your credit card number, the type of card [i.e. visa] and its expiry date below. Please also provide the CVN number at the back of the card
Declaration
*
Please confirm you agree to the following:-
• I declare that I am 18 years or older.
• I declare that all information provided to BSV is true and correct.
• I agree to immediately notify L&GNSW of any change to the information in this application before the application is determined.
• I acknowledge that under section 36 of the Gaming and Liquor Administration Act 2007 and section 307A of the Crimes Act 1900 it is an offence to provide false, misleading or incomplete information in this application.
• I acknowledge that failure to provide all required information may result in delay, withdrawal or refusal of my application.
• I understand that specific details I have supplied in this application may be ‘personal information’ under the Privacy and Personal Information Protection Act 1998. Personal information is any information or opinion that identifies an individual, or enables someone to identify an individual.
• I acknowledge that L&GNSW is collecting information on behalf of the Independent Liquor & Gaming Authority (ILGA) to enable processing of the application.
• I also understand that L&GNSW will use this information for its intended purpose only, store the information securely, and allow the applicant or licensee to access and update the information. When processing this application, L&GNSW may need to disclose information to other Government agencies.
