Application for Liquor Permit – All areas except East
Arnhem, Maningrida & Groote Eylandt
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 either
Darwin or Alice Springs Licensing, Regulation and Alcohol Strategy Office.
Darwin LRAS fax (08) 8999 7498 or e-mail LRASComplianceDWN.DOB@nt.gov.au
Alice Springs LRAS fax (08) 8951 5112 or e-mail LRASComplianceASP.DOB@nt.gov.au
Application for Liquor Permit
Applicant details
Title
Mr
Mrs
Ms
Miss
Full name (include middle name)
Date of birth
Residential address in
Community
Telephone
Email
Please choose from the following
I am a permanent resident
I am a contractor
I am a tourist
I will be in the below community between
and
(enter dates)
Location (Please tick your location and specify as needed)
Barunga
Beswick
Gunbalanya
Jay Creek
Kalkaringi
Lajamanu
Nauiyu
Peppimenarti
Tiwi Islands
Wadeye
Wudikapildiyea
Yuendumu
Other: (insert nearest community)
Specify Community or permit type
In applying for this permit I understand and give approval for the relevant authority to
conduct any checks, to ascertain if I am a fit and proper person to hold a liquor permit. I
also understand that a breach of the criteria may result in my permit being revoked.
Applicant’s
signature
Department of Business
Date
Page 1 of 3
Application for Liquor Permit
Application for Liquor Permit
Permit Criteria
That the Applicant has not:
a) caused substantial annoyance or disrupted community order and peace; or
b) assaulted any person or been involved in alcohol-related domestic or family
violence or traffic or vehicular incidents; or
c) illegally brought liquor into, or possessed liquor in, a restricted area; or
d) brought a dangerous drug (defined in the Misuse of Drugs Act) into, or
possessed a dangerous drug in, a restricted area; or
e) supplied liquor to another person who is not a permit holder or who is not an
invited guest of the permit holder; or
f) supplied a dangerous drug to another person; or
g) been banned from any of the licensed premises in the restricted area; or
h) breached any of the conditions of the permit or;
i) upon notification that an order has been made by any Court or Tribunal
prohibiting a person from possessing, consuming or purchasing liquor
Specific Conditions
Liquor may only be taken into the restricted area via Tiwi Barge, after
being purchased from a retailer situated outside the Tiwi Islands.
The maximum limits that may be taken into the restricted area by permit holders on a
weekly basis is one of the following:
One (1) carton of light beer (24 x 375ml cans, less than 3%), or One (1) carton of midstrength beer (24 x 375ml cans, 3% - 4%), or Two (2) six packs of full strength beer (12 x
375ml cans, over 4%), or Two (2) six packs of premix drinks (12 x 375ml), or Three (3)
bottles of wine (750ml, not fortified)
Tiwi Islands:
Yuendumu:
For the duration of the sports weekend, no liquor is to be consumed at
the community by permit holders.
Other special conditions determined
by committee and/or police (if applicable)
Recommendation/Approval
Council/Permit Committee
Chairman
Recommended
Not recommended
Name
Signature
Police delegate
Date
Recommended
Not recommended
Reason if “Not Recommended”
Name
Signature
Department of Business
Date
Page 2 of 3
Application_for_liquor_permit_form
Application for Liquor Permit
Application for Liquor Permit
Director-General of Licensing
Approved
Not approved
Name
Signature
Date
Permit number
Expiry date
General 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
General Restricted Area
2.
The permit holder may only possess and consume liquor at their home residence
or the residence of other permit holders within the General Restricted Area the
permit relates to or those areas are defined as exempt within the Restricted Area
3.
A permit may be revoked by the Director-General at their discretion
A permit may also be revoked upon application to the Director-General signed by
the Liquor Permits Committee or a member of the NT Police if the permit holder
does one or more of the following:
a) caused substantial annoyance or disrupted community order and peace; or
b) assaulted any person or been involved in alcohol-related domestic
violence or traffic or vehicular incidents; or
c) illegally brought liquor into, or possessed liquor in a restricted area; or
d) brought a dangerous drug (defined in the Misuse of Drugs Act) into, or
possessed a dangerous drug in, a restricted area; or
e) supplied liquor to another person who is not a permit holder or who is not
an invited guest of the permit holder; or
f) supplied a dangerous drug to another person; or
g) been banned from any of the licensed premises in the restricted area: or
h) breached any conditions of the permit; or
i) upon notification that an order has been made by any court or Tribunal
prohibiting a person from possession, consuming or purchasing liquor
4.
5.
A person whose permit has been revoked may reapply for a new liquor permit by
submitting a new application form
For more information please contact:
Licensing, Regulation and Alcohol Strategy
Department of Business
Darwin Licensing Officer
Phone
(08) 8999 1800
Facsimile
Email
LRASComplianceDWN.DOB@nt.gov.au
(08) 8999 7498
Alice Springs Licensing Officer
Phone
(08) 8951 5195
Email
LRASComplianceASP.DOB@nt.gov.au
Department of Business
Facsimile
(08) 8951 5112
Page 3 of 3
Application_for_liquor_permit_form