Liquor Permit Application for Groote Eylandt General Restricted Area

Transcription

1 Liquor Permit Application for Groote Eylandt General Restricted Area Please print in block letters. All questions relating to the applicant must be answered and full particulars provided. Once this application form has been completed it can be faxed to (08) faxed to (08) / / Type of application: New Reinstatement Review 1. Applicant details Title Mr Mrs Ms Miss Full name of birth Name of employer Residential Address (Address you are staying at on Groote Eylandt) Postal Address (or your usual place of residence if not a permanent or full time resident of the region) Telephone/Mobile Do you identify yourself as Are you staying in Groote Eylandt permanent or Temporary Alcohol Preference (please tick) (optional) Aboriginal Torres Strait Islander Both Aboriginal and Torres Strait Islander Non-Indigenous Overseas visitor Permanent (permit period is three years from date of issue) Temporary - dates permit required: / / - / / Full strength Mid strength Low strength Wine Pre-Mixed Department of Business Page 1 of 5

2 2. Declaration by applicant I agree that I have read and understood the attached conditions, or have had the conditions explained to me and understand them, and agree to abide by them. I understand that if I do not abide by the attached conditions, then the Director-General of Licensing may revoke or amend the permit. I also understand that I may appeal a decision about the refusal, revocation or amendment of the permit by making a request in writing seeking a review. Signature of applicant Signature of witness 3. Information for permit holder Holding a liquor permit enables you to purchase and/or bring liquor into the Restricted Area or obtain it from premises within the Restricted Area that are licensed to sell liquor for removal and consumption away from the premises and consumed in the prescribed/restricted area but not in quantities greater than, and not of types difference from those that are specified in the permit. 4. Privacy Statement I acknowledge that the information in this Permit Application and any information regarding liquor purchases made in accordance with the permit may be provided to Northern Territory Police and Licensing Inspectors of Licensing, Regulation & Alcohol Strategy for the purposes of enforcement and compliance with the Liquor Act. I understand that I have the right to inspect any and all information so compiled. I hereby consent to a check of the records of the Northern Territory Police and release of details of any convictions, or other information, including, pursuant to section 15 of the Criminal Records (Spent Convictions) Act 1992, recorded against my name, either in the Northern Territory or elsewhere. Further, I hereby indemnify the Northern Territory of Australia, its servants and agents, including all members of the NT Police against all liabilities and against all actions, suits, proceedings, claims, demands, costs and expenses whatsoever which may be taken or made in respect of the release or use hereunder of any details of any convictions or other information purporting to either relate to or involve me. Department of Business Page 2 of 5

3 5. This section is to be completed by the delegate of the NT Police Is the applicant recommended or not recommended Name Recommended Not Recommended Signature 6. This section is to be completed by the Director-General of Licensing Is the applicant approved or not approved Permit # Name Approved Not Approved Signature Department of Business Page 3 of 5

4 Terms and Conditions Required as a Holder of a Liquor Permit 1. Applicants must have attained the age of 18 years and be a resident of the Groote Eylandt General Restricted Area. 2. All liquor purchased in accordance with the permit is to be obtained at licensed premises by the permit holder only and by no other person. 3. The permit holder may only possess or consume liquor at their home residence or the residence of other permit holders within the Groote Eylandt General Restricted Area or those areas defined as exempt areas within Groote Eylandt. 4. A permit may be revoked by the Director-General of Licensing at his discretion. 5. A permit may also be revoked upon application to the Director-General of Licensing with a recommendation from the Liquor Permits Committee or a member of the Northern Territory Police, if the permit holder does one or more of the following: a) causes an alcohol related criminal act, substantial annoyance or disruption of community order and peace; or b) assaults any person or is involved in alcohol-related domestic or family violence; or c) unlawfully brings liquor into, possesses, consumes or controls liquor within a Restricted Area; or d) unlawfully supplies liquor to any person under the age of 18 years; or e) supplies liquor to another person who is not a permit holder; (The Liquor Act does provide for a permit holder to supply liquor to a non-permit holder, however that non-permit holder must reside outside the General Restricted Area). f) supplies a dangerous drug to another person, or possesses a trafficable quantity of a dangerous drug; g) litters the Restricted Area with refuse from the liquor obtained in accordance with a permit; or h) unlawfully possesses, supplies or brings kava into the General Restricted Area; or i) commits a drink driving offence with a blood alcohol content of 0.08% or greater or fails to provide a sufficient sample of breath for breath analysis; or j) if a Trespass Notice is issued from either a licensed premises or private/public event, a Liquor Permit may be revoked at the Director- General of Licensing s discretion; or k) breaches any of the conditions of their permit. 6. A person whose permit has been revoked may reapply for a new liquor permit by completing application forms and appealing to the Director-General of Licensing. Department of Business Page 4 of 5

5 For more information please contact: Licensing, Regulation and Alcohol Strategy Department of Business Darwin Licensing Inspector Ph: (08) Office Hours: 8.00am 4:00pm Licensing, Regulation and Alcohol Strategy Department of Business Nhulunbuy Licensing Officer Ph: (08) Department of Business Page 5 of 5