Western Australian Current Regulations Western Australian Current Regulations[Regulation 3]
[Forms 1‑18 deleted: Gazette 1 May 2007 p. 1887.]
Form 19
[Regulation 19(1)]
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Application Form for Liquor Subsidy (WA Producers Only) | |||
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1. CLAIM FOR THE MONTH/PERIOD OF: | | | |
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Month/Quarter |
Year | |
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2. AUSTRALIAN BUSINESS NUMBER: | | ||
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3. LIQUOR LICENCE NUMBER: | | | | | | | | |
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4. NAME OF PREMISES: | | |||
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5. NAME OF LICENSEE: | | |||
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ADDRESS OF LICENSED | | |||
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Postcode | ||
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6. AMOUNT OF SUBSIDY CLAIM: |
(a) WET subsidy claimable for Cellar door sales to
persons other than liquor merchants (including sales made in a restaurant on
the licensed premises). ....................................... |
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(b) WET subsidy claimable for Mail Order Sales.
.............................................................. |
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(a) + (b) + (c) = Total for this
period |
(c) WET subsidy claimable for Tastings, promotions
and donations for which no charge has been made.
.................................. |
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TOTAL FOR THIS PERIOD: |
$ | ||
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7. ADJUSTMENTS (IF APPLICABLE): |
(e) Amount overpaid/underpaid for the month of
.................................................................... |
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TOTAL AMOUNT CLAIMED: |
$ | ||
Have your bank details changed? No
❒ Yes
❒ If yes please provide new bank details below:
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BANK NAME: | |
BRANCH NAME: | |
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BSB No. | |
ACCOUNT No: | |
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8. DECLARATION: I,
_______________________________________________ certify that: name of licensee | |
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(a) I am the licensee of the above named premises;
and (b) the claim I am making for liquor subsidy is
complete, true and correct; and (c) the claim I am making is honestly based on my
WET obligations; and (d) I have all the necessary records to provide
information to substantiate my claim; and |
WARNING Penalties apply if you provide false or misleading information |
|
(e) I will provide information to substantiate my
claim, if requested, at any time by the relevant authorities; and (f) I have prepared and issued invoices reflecting
the liquor subsidy in accordance with requirements of the Australian Taxation
Office; and (g) my prices to my customers incorporate the
amount of the subsidy. | |
WHERE THE LICENSEE IS A COMPANY:
The common seal of ________________________________ was hereunto affixed by
order of its Directors in accordance with its Articles of Association, in the
presence of:
Name and Signature of Director(s)
Common Seal
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
WHERE THE LICENSEE IS ONE OR MORE INDIVIDUAL PERSONS:
Signature(s)
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
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FOR OFFICE |
DATE RECEIVED: ____ / ____ / _ ___ |
AMOUNT PAYABLE: $ |
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USE ONLY |
DATE PAID: ____ / ____ / ____ |
PAYMENT DETAILS: |
[Form 19 inserted: Gazette 9 Jul 2004
p. 2774‑5.]
Form 19A
[Regulation 19(1)]
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Application for Liquor Subsidy — Low Alcohol (WA Wholesalers/Beer Producers) | |||
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1. CLAIM FOR THE MONTH/PERIOD OF: | | | |
| |
Month/Quarter |
Year | |
|
2. AUSTRALIAN BUSINESS NUMBER: | | | |
| | | | |
|
3. LIQUOR LICENCE NUMBER: | | | | | | | | |
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4. NAME OF PREMISES: | | |||||
| | | | | |||
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5. NAME OF LICENSEE: | | |||||
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ADDRESS OF LICENSED PREMISES: | | |||||
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Postcode | ||||
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6. AMOUNT OF SUBSIDY CLAIM: |
Low Alcohol Beer |
$ | ||||
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Low Alcohol Wine |
$ | |||||
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TOTAL FOR THIS PERIOD: |
$ | ||||
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7. ADJUSTMENTS (IF APPLICABLE): |
Amount overpaid/underpaid for the month of
..............................................................................
|
| ||||
| |
TOTAL AMOUNT CLAIMED: |
$ | ||||
Have your bank details changed? No
❒ Yes
❒ If yes please provide new bank details below:
|
BANK NAME: | |
BRANCH NAME: | |
|
BSB No. | |
ACCOUNT No: | |
|
8. DECLARATION: I,
_______________________________________________ certify that: name of licensee | |
|
(a) I am the licensee of the above named premises;
and (b) the claim I am making for liquor subsidy is
complete, true and correct; and (c) I have all the necessary records to provide
information to substantiate my claim; and |
WARNING |
|
(d) I will provide information to substantiate my
claim, if requested, at any time by the relevant authorities; and (e) I have prepared and issued invoices reflecting
the liquor subsidy; and (f) my prices to my customers incorporate the
amount of the subsidy. | |
WHERE THE LICENSEE IS A COMPANY:
The common seal of ________________________________ was hereunto affixed by
order of its Directors in accordance with its Articles of Association, in the
presence of:
Name and Signature of Director(s) Common Seal
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
WHERE THE LICENSEE IS ONE OR MORE INDIVIDUAL PERSONS:
Signature(s)
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
________________________________ Date: ____ / ____
/ ____ Ph No: _________________
|
FOR OFFICE |
DATE RECEIVED: ____ / ____ / ____ |
AMOUNT PAYABLE: $ |
|
USE ONLY |
DATE PAID: ____ / ____
/ ____ |
PAYMENT DETAILS: |
[Form 19A inserted: Gazette 9 Jul 2004
p. 2776‑7.]
Form 20
[Section 161]
SEARCH WARRANT
Under section 161 of the Liquor Control Act 1988 1 I, [insert
name of Justice of the Peace granting the warrant], of
.............................................................................................................................................
being a Justice of the Peace and being satisfied upon application by [insert
name of applicant] that there is reason to suspect that [insert description of
circumstances justifying issue of warrant]
.................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
at [insert address of premises]
............................................................................................
.............................................................................................................................................
hereby grant to [insert name and designation of authorised officer]
..................................
.............................................................................................................................................
this warrant empowering that person to enter those premises with such other
persons as may be necessary to assist, using such force as may be necessary,
and there to do any of the things referred to in section 161(1). This
warrant continues to have effect until the purposes for which it was granted
are satisfied.
Granted on the ........................... day of
.................................................. 20 .....................
at
.........................................................................................................................................
.................................................................
Signature of
Justice of the Peace granting
the warrant
[Form 20 amended: Gazette 28 Sep 2007
p. 4930‑1.]
[Forms 21 and 22 deleted: Gazette 2 Oct 2018 p. 3801.]