[Regulation 13]
Item |
Category of applicant |
Details to be provided |
---|---|---|
1. |
Natural person ................ |
(a) full name; and |
| |
(b) any other name used now or previously; and |
(c) present residential address; and | ||
| |
(d) any other residential address in the past
5 years, including dates of each change of address; and |
| |
(e) date and place of birth; and |
| |
(f) citizenship; and |
| |
(g) if the applicant has a spouse or de facto
partner who will assist in the conduct of business under the licence, the full
name and date of birth of the spouse or de facto partner; and |
| |
(h) present occupation, and name and address of
employer; and |
| |
[(j) deleted] |
| |
(k) licences relating to the sale of liquor held
in the State or elsewhere, the name and address of premises to which any such
licence relates or related and the period during which the licence is or was
held; and |
| |
(m) any other involvement in the operation of
licences relating to the sale of liquor in the State or elsewhere; and |
| |
(n) any position of authority held in a body
corporate concerned with the proposed licence and a description of the
position held; and |
| |
(o) the number and nature of any convictions of
that person for offences in any jurisdiction; and |
| |
(p) any proceedings relating to insolvency under
administration, within the meaning of the Corporations Act 2001 of the
Commonwealth, in respect of the person or any such proceedings, or
applications in respect of any such proceedings, pending in respect of the
person; and |
| |
(q) any external administration, within the
meaning of the Corporations Act 2001 of the Commonwealth, of any
corporation of which the person is — |
| |
(i)
a director; or |
| |
(ii)
where the corporation is a proprietary company, a
shareholder, |
| |
or any such administration pending. |
2. |
Company .......................... |
(a) full name, registered office and address for
service of documents; and |
| |
(b) date and place of incorporation, including a
copy of the certificate of incorporation; and |
| |
(c) any change of the company name during the past
2 years, including the date of any such change of name; and |
| |
(d) a list of directors; and |
| |
(e) in respect of each director, the details set
out in item 1; and |
| |
(f) in the case of a proprietary
company — |
| |
(i)
the full name, residential address and date of birth of
each shareholder who is a natural person; and |
| |
(ii)
the full name, date and place of incorporation of each
shareholder that is a body corporate; and |
| |
(g) any liquidation, receivership or official
management in force or pending in respect of the company; and |
| |
(h) the full name, date and place of incorporation
of any related body corporate, and the nature of the relationship; and |
| |
(j) in respect to any person sought to be approved
as manager, the details set out in the third column of item 1. |
3. |
Club or other body of persons ............................. |
(a) full name and address for service of
documents; and |
| |
(b) date and place of formation; and |
| |
(c) any change of name in the past 2 years;
and |
| |
(d) if incorporated, the date and place of
incorporation, including a copy of the certificate of incorporation; and |
|
(e) the full name of, residential address of, and
office held by, any trustee or office bearer and the date of that
person’s appointment or election as the case may be; and | |
| |
(f) in respect of any person sought to be approved
as manager, the details set out in the third column of item 1. |
[Schedule 2 amended: Gazette
22 May 1998 p. 2944; 6 Oct 1998 p. 5567;
28 Sep 2001 p. 5357‑8; 30 Jun 2003
p. 2612; 24 Oct 2008 p. 4683‑4.]