Notice Of Management Change - Carterton District Council
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1Notice of Management Change
Section 231 Sale and Supply of Alcohol Act 2012
Forward a copy of this completed form within two working days of the Manager’s appointment or termination to:
Carterton District Licencing Committee
New Zealand Police
c/o Carterton District Council
PO Box 443, Masterton 5840
PO Box 9, Carterton 5743
Attn: Alcohol Harm Reduction Officer
Email: cartertondlc@cdc.govt.nz
Email: wairarapa.police@police.govt.nz
Fax: 06 379 7832
Fax: 06 370 5950
Licenced Premises Name
Licenced Premises Address
Telephone
Email
A person appointed as duty manager must be 20 years or older.
What are you notifying (please select one box):
New Certificate Holding Manager
Full Name
Certificate Number
Certificate Expiry Date
dd / mm / yyyy
Effective From
dd / mm / yyyy
to
dd / mm / yyyy
Temporary Manager (s229 Sale and Supply of Alcohol Act 2012)
Attach a copy of your drivers
Full Name
licence or passport
Residential Address
Who they are replacing
Certificate No
Reason
Effective From
dd / mm / yyyy
to
dd / mm / yyyy
Temporary Managers must apply for a Manager’s Certificate within two working days of their appointment.
Acting Manager (s230 Sale and Supply of Alcohol Act 2012) - maximum appointment 3 weeks
Attach a copy of your drivers
Full Name
licence or passport
Residential Address
Who they are replacing
Certificate No
Reason
Effective From
dd / mm / yyyy
to
dd / mm / yyyy
Termination/Cancellation of Manager Appointment
Full Name
Certificate Number
dd / mm / yyyy
Certificate Expiry Date
Effective From
dd / mm / yyyy
Licensee’s Signature
dd / mm / yyyy
Date
Name
Position
(director, partner, etc.)
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Parent category: Business