Transfer an existing licence or permit - VCGLR

Application
Transfer an existing
licence or permit
Liquor Control Reform Act 1998
Licence or permit number
Contact details for person completing this application
Contact name
Fax number Email
Postal address
Premises details
Trading name at premises (ie registered business name)
Street address
Postal address (for service of notices if different from street address)
Daytime telephone number
Premises email
Details of current licensee/permit holder or owner/mortgagee (the transferor)
Who is applying for this transfer?
The current licence/permit holder OR
Postcode
Postcode
Postcode
The owner/mortgagee of the licensed premises because the licence/permit holder has been legally evicted or has
deserted the licensed premises
Name of current licensee/permit holder or owner/mortgagee (person/partnership/company/club) ACN (if applicable)
Signature of transferor
Who must sign this application - If the licensee/permit holder or owner/mortgagee is:
An individual The individual person - A company One director of the company - A partnership All partners - A club One committee
member
Certification
I/We apply to transfer the licence as outlined in this application.
Name
Date
/ /
Name
OFFICE USE ONLY TRANS-02/12
Date Rec’d / /
Receipt No. ____________________
File No. _______________________
Person in management or control of the premises (body corporate applicants only)
Any body corporate applicant (this includes applicants that are a
company, incorporated association, a co-operative or a council)
must nominate the person in management or control of the
premises.
The person in management or control is the person who will run
the day-to-day operations of the business.
Name
Victorian Commission for Gambling and Liquor Regulation
49 Elizabeth Street, Richmond VIC 3121
(Hours: 8:30 - 5:00) Monday to Friday – closed on public holidays
GPO Box 1988, Melbourne VIC 3001
Date
Please attach evidence of completion
/ /
Has this person completed an approved RSA training program?
YES
NO
Telephone 1300 182 457
www.vcglr.vic.gov.au
DX 210976
ABN 56 832 742 797
Privacy – the Victorian Commission for Gambling and Liquor Regulation is committed
to responsible and fair handling of personal information consistent with the Information
Privacy Act 2000 and its obligations under the Liquor Control Reform Act 1998. All
information provided in this application is available for public viewing, except for the
questionnaire form (if applicable) which is forwarded to and retained by Victoria Police.
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