FORM B
COMMONWEALTH OF AUSTRALIA
STATUTORY DECLARATION



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Airports Control of On-Airport Activities Regulations 1997 (as amended)


For the purposes of making a decision in relation to the application for a licence/appointment as nominee, the relevant decision-maker shall consider a range of matters, including but not limited to, the applicant's understanding of the obligations of a licensee under these Regulations.

To enable the relevant decision-maker to assess your understanding you are required to state your understanding of the obligations you would assume under the Airports Control of On-Airport Activities Regulations 1997 (as amended) if you were granted the licence or appointed as a nominee.

This declaration is compulsory and it will form part of the consideration as to whether you are a fit and proper person to hold a liquor licence or be appointed as a nominee. It should be completed in your own handwriting and be accompanied by evidence of the training courses you have undertaken in relation to the responsible service of alcohol.

Name:

  

My understanding of my obligations regarding the responsible service of alcohol are:

 

Form B - Statutory Declaration - Page 2

I make this solemn declaration by virtue of the Statutory Declarations Act 1959 as amended and subject to the penalties provided by the Act for the making of false statements in statutory declarations, conscientiously believing the statements contained in this declaration to be true in every particular.










Declared at      on   

Before me,






Signature and title of person before whom the declaration is made

(Commissioner for Declarations Justice of the Peace or a Public Servant of 5 years standing)





Note: A person who wilfully makes a false statement in a statutory declaration under the Statutory Declarations Act 1959 as amended is guilty of an offence against that Act, the punishment of which is a fine not exceeding $200 or imprisonment for a term not exceeding 6 months or both if the offence is prosecuted summarily, or imprisonment for a term not exceeding four years if the offence is prosecuted upon indictment