LIQUOR LICENCE CHECKLIST - ArtisanOz Consulting

LICENSED PREMISES DETAILSLIQUOR LICENCE CHECKLISTPERSONAL DETAILS OF PROPOSED LICENCE HOLDERPERSONAL DETAILS OF OTHER PERSON/S INVOLVEDCOMPANY DETAILS OF LICENSED PREMISESOWNER OF BUILDING DETAILSLICENSEE’S COURSE CERTIFICATERSA COURSE CERTIFICATEPLAN OF PREMISES SHOWING SEATING ARRANGEMENT(NEW APP ONLY)COPY OF SIGNED LEASE AGREEMENTCOPY OF MENU(NEW APP ONLY)LIST OF ALL ITEMS CONTAINED WITHIN LICENSED PREMISES(NEW APP ONLY)CERTIFICATE OF REGISTRATION OF BUSINESS NAME(NEW APP ONLY)DEVELOPMENT APPLICATION APPROVAL(NEW APP ONLY)APPROVAL LETTER FROM LANDLORD GIVING PERMISSION(NEW APP ONLY)ANY INQUIRIESPLEASE CONTACT:SHANE WORKMANARTISANOZ CONSULTINGMOBILE: 0404 488 855 EMAIL: shane@aoh.com.auFAX: 02 9739 8955 WEB: www.aoh.com.auPAGE 1 OF 5

LIQUOR LICENCE INFORMATION SHEETPLEASE PRINT CLEARLY LICENSED PREMISES DETAILS PLEASE PRINT CLEARLYNAME OF PROPOSED PREMISES:(As shown on Registration of Business Name)ADDRESS OF PREMISES:STREET ADDRESSSUBURB STATE POSTCODESANITARY FACILITIESMALE TOILET(S): URINAL(S): WASH BASIN(S):Eg. 1 person, 3 personFEMALE TOILET(S): WASH BASIN(S):UNISEX TOILET(S): WASH BASIN(S):DISABLED TOILET(S): WASH BASIN(S):SEATINGINDOOR SEATING (GROUND FLOOR): INDOOR SEATING (FIRST FLOOR):OUTDOOR SEATING:TOTAL SEATING WITHIN LICENSED PREMISES:ON-PREMISES LICENCE ONLY KITCHEN FACILITIES ON-PREMISES LICENCE ONLYLIST OF ITEMS CONTAINED WITHIN KITCHENPAGE 2 OF 5

LICENSEE’S NAME:LIQUOR LICENCE INFORMATION SHEETPERSONAL DETAILS OF PROPOSED LICENCE HOLDERCURRENT ADDRESS:STREET ADDRESSSUBURB STATE POSTCODEYEAR FROM:YEAR TO:PREVIOUS ADDRESS:(within the last 10 years)STREET ADDRESSSUBURB STATE POSTCODEYEAR FROM:YEAR TO:PREVIOUS ADDRESS:(within the last 10 years)STREET ADDRESSSUBURB STATE POSTCODEYEAR FROM:YEAR TO:DATE OF BIRTH: I IPLACE OF BIRTH:IF NOT BORN IN AUSTRALIA, YOUR DATE OF ARRIVAL: I iPAGE 3 OF 5

LIQUOR LICENCE INFORMATION SHEETPERSONAL DETAILS OF PROPOSED LICENCE HOLDER - CONTINUEDHOME PHONE:WORK PHONE:MOBILE PHONE:DRIVER’S LICENCE NO:HEIGHT: EYE COLOUR: BUILD:HAIR COLOUR:SKIN COMPLEXION:ANY FEATURES: (eg. Tattoo’s or scars)CRIMINAL HISTORY:SPEEDING FINES:(EG. WITHIN THE LAST 10 YEARS)PARKING FINES:(EG. WITHIN THE LAST 10 YEARS)HAVE YOU EVER BEEN BANKRUPT BEFORE? IF SO WHEN?:PERSONAL DETAILS OF OTHER PERSON/S INVOLVED IN LICENSED PREMISESNAME:ADDRESS:STREET ADDRESSDATE OF BIRTH: I ISUBURB STATE POSTCODEPLACE OF BIRTH:IF NOT BORN IN AUSTRALIA, YOUR DATE OF ARRIVAL: I IHOME PHONE:WORK PHONE:MOBILE PHONE:PAGE 4 OF 5

COMPANY NAME:LIQUOR LICENCE INFORMATION SHEETDETAILS OF COMPANY INVOLVED IN LICENSED PREMISESADDRESS OF BUSINESS:STREET ADDRESSACN / ABN:SUBURB STATE POSTCODECOMPANY NAME:(If Company)COMPANY ADDRESS:COMPANY DETAILS / PERSONAL DETAILS OF OWNER OF BUILDINGSTREET ADDRESSACN / ABN:SUBURB STATE POSTCODEOWNER’S NAME:ADDRESS:STREET ADDRESSDATE OF BIRTH: I ISUBURB STATE POSTCODEPLACE OF BIRTH:IF NOT BORN IN AUSTRALIA, YOUR DATE OF ARRIVAL: I iPAGE 5 OF 5