Liquor Permit Application for Groote Eylandt General
Restricted Area
Please print in block letters. All questions relating to the applicant must be answered
and full particulars provided.
Once this application form has been completed it can be faxed to (08) 8999 7498. Date
faxed to (08) 8999 7498 ___/___/___
Type of application:
New
Reinstatement
Review
Liquor Permit Application for Groote Eylandt General Restricted Area
1. Applicant details
Title
Mr
Mrs
Ms
Miss
Full name
Date of birth
Name of employer
Residential Address (Address you
are staying at on Groote Eylandt)
Postal Address (or your usual place
of residence if not a permanent or full
time resident of the region)
Telephone/Mobile
Do you identify yourself as
Are you staying in Groote
Eylandt permanent or
Temporary
Email (optional)
Aboriginal
Torres Strait Islander
Both Aboriginal and Torres Strait Islander
Non-Indigenous
Overseas visitor
Permanent (permit period is three years from date of issue)
Temporary
- dates permit required: __/__ /__-__/__/__
Alcohol Preference (please tick)
Department of Business
Full strength
Mid strength
Low strength
Wine
Pre-Mixed
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Liquor Permit Application for Groote Eylandt General Restricted Area
Liquor Permit Application for Groote Eylandt General Restricted Area
2. Declaration by applicant
I agree that I have read and understood the attached conditions, or have had the
conditions explained to me and understand them, and agree to abide by them. I
understand that if I do not abide by the attached conditions, then the Director-General of
Licensing may revoke or amend the permit. I also understand that I may appeal a
decision about the refusal, revocation or amendment of the permit by making a request
in writing seeking a review.
Signature of applicant
Date
Signature of witness
Date
3. Information for permit holder
Holding a liquor permit enables you to purchase and/or bring liquor into the Restricted
Area or obtain it from premises within the Restricted Area that are licensed to sell liquor
for removal and consumption away from the premises and consumed in the
prescribed/restricted area but not in quantities greater than, and not of types difference
from those that are specified in the permit.
4. Privacy Statement
I acknowledge that the information in this Permit Application and any information
regarding liquor purchases made in accordance with the permit may be provided to
Northern Territory Police and Licensing Inspectors of Licensing, Regulation & Alcohol
Strategy for the purposes of enforcement and compliance with the Liquor Act. I
understand that I have the right to inspect any and all information so compiled.
I hereby consent to a check of the records of the Northern Territory Police and release
of details of any convictions, or other information, including, pursuant to section 15 of
the Criminal Records (Spent Convictions) Act 1992, recorded against my name, either
in the Northern Territory or elsewhere. Further, I hereby indemnify the Northern Territory
of Australia, its servants and agents, including all members of the NT Police against all
liabilities and against all actions, suits, proceedings, claims, demands, costs and
expenses whatsoever which may be taken or made in respect of the release or use
hereunder of any details of any convictions or other information purporting to either
relate to or involve me.
Department of Business
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Liquor Permit Application for Groote Eylandt General Restricted Area
Liquor Permit Application for Groote Eylandt General Restricted Area
5. This section is to be completed by the delegate of the NT Police
Is the applicant recommended or not
recommended
Recommended
Not Recommended
Name
Signature
Date
6. This section is to be completed by the Director-General of Licensing
Is the applicant approved or not
approved
Approved
Not Approved
Permit #
Name
Signature
Department of Business
Date
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Liquor Permit Application for Groote Eylandt General Restricted Area
Liquor Permit Application for Groote Eylandt General Restricted Area
Terms and Conditions Required as a Holder of a Liquor Permit
1.
Applicants must have attained the age of 18 years and be a resident of the
Groote Eylandt General Restricted Area.
2.
All liquor purchased in accordance with the permit is to be obtained at
licensed premises by the permit holder only and by no other person.
3.
The permit holder may only possess or consume liquor at their home
residence or the residence of other permit holders within the Groote Eylandt
General Restricted Area or those areas defined as exempt areas within
Groote Eylandt.
4.
A permit may be revoked by the Director-General of Licensing at his
discretion.
5.
A permit may also be revoked upon application to the Director-General of
Licensing with a recommendation from the Liquor Permits Committee or a
member of the Northern Territory Police, if the permit holder does one or
more of the following:
a) causes an alcohol related criminal act, substantial annoyance or
disruption of community order and peace; or
b) assaults any person or is involved in alcohol-related domestic or family
violence; or
c) unlawfully brings liquor into, possesses, consumes or controls liquor
within a Restricted Area; or
d) unlawfully supplies liquor to any person under the age of 18 years; or
e) supplies liquor to another person who is not a permit holder;
(The Liquor Act does provide for a permit holder to supply liquor to a
non-permit holder, however that non-permit holder must reside outside
the General Restricted Area).
f) supplies a dangerous drug to another person, or possesses a
trafficable quantity of a dangerous drug;
g) litters the Restricted Area with refuse from the liquor obtained in
accordance with a permit; or
h) unlawfully possesses, supplies or brings kava into the General
Restricted Area; or
i) commits a drink driving offence with a blood alcohol content of 0.08%
or greater or fails to provide a sufficient sample of breath for breath
analysis; or
j) if a Trespass Notice is issued from either a licensed premises or
private/public event, a Liquor Permit may be revoked at the DirectorGeneral of Licensing’s discretion; or
k) breaches any of the conditions of their permit.
6.
A person whose permit has been revoked may reapply for a new liquor permit
by completing application forms and appealing to the Director-General of
Licensing.
Department of Business
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Liquor Permit Application for Groote Eylandt General Restricted Area
Liquor Permit Application for Groote Eylandt General Restricted Area
For more information please contact:
Licensing, Regulation and Alcohol
Strategy
Department of Business
Darwin Licensing Inspector
Ph: (08) 8999 1800
Licensing, Regulation and Alcohol
Strategy
Department of Business
Nhulunbuy Licensing Officer
Ph: (08) 8987 0451
Office Hours: 8.00am – 4:00pm
Department of Business
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