Sale And Supply Of Alcohol Act - Notice Of Management Change - 2012

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NOTICE OF MANAGEMENT CHANGE
Section 231, Sale and Supply of Alcohol Act 2012
Name of Licensed Premises: _______________________________________________________________________________
Licensee: __________________________________________ Licence Number:
___________________________________
Address of Licensed Premises:
____________________________________________________________________________
Contact Phone: ( ______ ) ___________________________ Contact Fax:
( ______ ) ______________________________
What are you notifying? (Please tick and complete the applicable box below)
New Certificate Holding Manager
Full Name: _________________________________________________
Effective from: _____________ / _____________ / 2 0 ____________
Certificate Number: ________________________________________
Certificate Expiry Date: _______________________________________
Temporary Manager
(see s.229, Sale and Supply of Alcohol Act)
Effective from: _____ /_____ / 2 0_____ to _____ /_____ / 2 0 _____
Full Name: _________________________________________________
Date of Birth: ________________________________________________
Residential Address: _________________________________________________________________________________________________________
Who they are replacing: _____________________________________ Certificate Number: ___________________________________________
Reason: _____________________________________________________________________________________________________________________
Note that a temporary manager must apply for a manager’s certificate within two working days of their appointment.
Acting Manager
(see s.230, Sale and Supply of Alcohol Act)
Effective from: _____ /_____ / 2 0_____ to _____ /_____ / 2 0 _____
Full Name: _________________________________________________
Date of Birth: ________________________________________________
Residential Address: _________________________________________________________________________________________________________
Who they are replacing: _____________________________________ Certificate Number: ___________________________________________
Reason: _____________________________________________________________________________________________________________________
Termination/Cancellation of Manager Appointment
Full Name: _________________________________________________
Effective from: _____________ / _____________ / 2 0 ____________
Certificate Number: ________________________________________
Certificate Expiry Date: _______________________________________
Forward a copy of this completed form, within two working days of the appointment (or termination), to:
Counties Manukau Police
managernotifications@aucklandcouncil.govt.nz
Auckland Police
North Shore Police
Private Bag 92002
Private Bag 76920
P.B.102912
Manukau 2241
Auckland 1142
North Shore Mail Centre
0745
Signature of licensee: ______________________________ Date: _______________________________________________
Name: _____________________________________________ Position (director, partner etc): ______________________

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