Commonwealth of Australia	
Application for a Liquor Licence	
Airports (Control of On-Airport Activities) Regulations 1997	
WARNING:  False or misleading statements will attract a penalty of $ and may lead to cancellation of the licence	

PLEASE PRINT USING BLOCK LETTERS AND ENSURE YOU ANSWER ALL QUESTIONS. FAILURE TO DO SO WILL RESULT IN A DELAY TO YOUR APPLICATION. 	

 	1. What type of licence are you applying for?
Passenger Terminal	

General	

Function	

2. What is the primary purpose of the business? 

3. Do you intend to conduct the following activities in conjunction with the sale or supply of alcohol?

i) Sale of petrol or petroleum related products
ii) Operate a mixed business or convenience store 

4. Full Name of Applicant 

	 	5. If the applicant is a company, or a person who will not be responsible for the day to day operation of the premises, you must have a responsible person as nominee. You must also have an alternative nominee. 

Full name of proposed nominee

Full name of proposed alternative nominee

6. Details of premises 

Name of premises (if applicable)

Address of premises

Phone number of premises

	
 	7. Is the premises situated 

i) On an airport site?

If yes, attach consent to operation of the business by the airport operator. 

ii) In an Airport Terminal at Sydney (Kingsford Smith) Airport? 

If yes, and this application is to run a business in the terminal, do not complete this application. You will need to contact the Airport Operator for further information. 

8. Property description 
(as recorded in your sub-lease) 

9. Describe the areas the premises is to consist of?
(including access, internal areas, relevant floor of building, access to toilets etc) 

10. Is the applicant a company? 

If yes, please attach a certificate of Registration of the Company and Notification of Office Holders (ASC form 215 or 305).

11. Your contact details for this application
Name:	

Address:	

	

Phone:	

Facsimile:	

E-mail:	

	

	 	12. You must be able to establish that you are a fit and proper person to sell and supply liquor to the public. 
Please make the declarations and supply the information set out in Forms A and B to this application. 

13. This application cannot be considered unless it is accompanied by a submission that demonstrates that there is a need for the licence 

The submission must contain the following information: 
(a)   the type, standard and quality of service you intend to provide;
(b)  the likely health and social impact the licence would have on the users of the airport;
(c)   the steps you will take to ensure that the licence will not impact adversely on the amenity of the airport. You will need to consider such matters as:
   (i)  noise
   (ii)  proximity to passenger lounges and waiting areas;
(d)  the number, type, standard and location of existing licensed premises on the airport site and the range and quality of services they provide.

14. The following items must be lodged with this application: 

a)  a scale plan of the premises showing the general layout
b)  a plan showing the location of the premises in relation to adjacent premises

15. You must provide evidence that you have advertised and displayed your application to the general public for at least 28 days before you submitted it. 

Is the evidence attached? 

Your application for general licence cannot proceed until this is attached.

16. You must provide evidence that you invited written comments from the public about your application. 

Are copies of the written comments attached?

None received (proceed to Q 18)    

17. You must provide a statement confirming: 

(i) that the public comments attached were the only ones you received; and
(ii) how you have taken those comments into account in this application	 	
	
 	18. Consent of nominee (as named in Question 5)
I,   	

consent to act as nominee for	

	

(name of applicant)	

 	

Signed	
 /      /        	

19. Consent of alternative nominee (as named in Question 5) 
I,   	

consent to act as nominee for	

	

(name of applicant)	

 	

Signed	
 /      /        	

	 	20. Checklist for Applicants 

Have all questions been answered as instructed 

Have all attachments been included, such as: 
•	Airport operator's consent (Q7) 
•	Registration of Company and Notification of Office Holders (Q10) 
•	Forms A & B (Q12) 
•	Need for a licence submission (Q13) 
•	Premises plans (Q14) 
•	Advertisement of application (Q15) 
•	Written Comments (Q16 where applicable) 
•	Statement (Q17 where applicable) 

21. Signature of Applicant (as named in Question 4) 
Name	

 	

Signed	
 /      /