For the purpose of section 71(c) of the Act, the prescribed particulars for an application for the renewal of registration of premises to which this Division applies are—
(a) the date of the application; and
(b) the name and address of the proprietor; and
(c) the business name (if any) of the proprietor; and
(d) the class or classes of business conducted at the premises; and
(e) the address of the premises; and
(f) the date of registration; and
(g) the registration number; and
(h) details of any renewals of registration; and
(i) any conditions on the registration.