Notification of Temporary or Acting Manager Appointment

*- indicates required field.

Complete this form to appoint an acting manager or temporary manager for your licensed premises. If you are unsure which appointment type is correct please contact the Liquor Licensing Inspector on 07 3760899 to discuss.

Type of appointment: *

Acting Manager (maximum 3 weeks)

Temporary Manager (must apply within 2 working days of appointment for Managers Certificate)

Appointee's Details

Full name: *

Residential address: *

Contact number: *

Date of birth: *

(Appointee must be aged 20 years or older)

Do you hold a New Zealand drivers licence? *

Yes

Start date of appointment: *

Premises Details

Name of premises in which appointee will manage: *

Address of licensed premises: *

Contact phone number: *

Contact email address: * HelpText