PUBLIC NOTICE

(CONFIRM THE FORMAT THAT MUST BE USED FROM YOUR LIQUOR AUTHORITY)

DATE: (Date of Placement of Notice for Public.)

Notice is hereby given that it is the intention of the person whose details are set out below to lodge an application for a LIQUOR STORE LICENSE (Type of Liquor License Applied for) to the secretary of the local committee / liquor authority at (Full Address of Authority where Application will be Submitted) on (Date of Submission of Application).

1 Full name of applicant: Business Name or Applicant Name

1. Intended Trading Name: Name of Store / Shop / Business
2. Identity Number or Registration number of the applicant: ____
3. Full address and location of the premises: (Include Full Address of Premises / Erf Number as per Zoning Certificate).
4. Type of license applied for: (Type of License Applied for).
5. Name and nature of educational institutions within a radius of 500 meters from the premises in paragraph 4: (Names of Educational Institutions / NONE if none).
6. Names and distances to similar licensed premises within a radius of 500 meters from the premises in paragraph 4. (Names of Similar Licensed Premises / NONE if none).
7. Places of worship within a radius of 500 meters from the premises in paragraph 4: (Names of Places of Worship / NONE if none).
8. Notices Published in Government Gazette and 2 Public Newspapers: YES / NO
9. REFERENCE NUMBER OF APPLICATION (AS GIVEN BY LIQUOR BOARD / LIQUOR AUTHORITY)

Contact Details of Applicant: (Name, Residential Address and Correspondence eMail Address of Applicant).

_______________________________.

Signature of Applicant.

I certify that this declaration has been signed and sworn before me at ______________________ this ___  day of ­­­­­­______ 2016 by the person authorised to sign on behalf of the license holder who acknowledged that:-

he/she knows and understands the contents of the declaration;

he/she has no objection to taking the prescribed oath; and

he/she considers the prescribed oath to be binding on his conscience.

“I swear that the contents of this declaration are true, so help me God”

_______________________________.

Commissioner of Oath.

Liquor License Price and Step by Step Liquor License Application Procedure Guide

THIS IS A SAMPLE OF WHAT DOCUMENT MUST INCLUDE. APPLICANT CAN MAKE CHANGES AS REQUIRED.