Templates for alcohol licensing forms

The Sale and Supply of Alcohol (Community Participation) Amendment Act 2023 has recently been introduced. These pages are currently being updated to reflect the new legislation.


Note: As of 12 July 2021 the forms used for applying to vary, suspend or cancel a licence (s 280) and a managers certificate (s 285) have been updated and approved by the Chief Executive of the Ministry of Justice pursuant to ss 280(2)(a)(external link) and 285(2)(a)(external link) of the Act. Notably:

  • the style has been changed to align with those used in relation to other tribunals and authorities;
  • minor updates have been made to simplify or clarify the language used consistent with the Act; and
  • the forms have been reformatted to enable them to be completed electronically (by way of tick boxes and drop-down menus).

Alcohol licensing form templates

ARLA Application for variation, suspension, or cancellation of licence (for on-licence, off-licence) [DOCX, 62 KB] (previously form 21)

ARLA Application for suspension, or cancellation of managers certificate [DOCX, 54 KB] (previously form 23)

Form 1 - Infringement notice [DOCX, 18 KB]

Form 2 - Infringement offence reminder [DOCX, 18 KB]

Form 3 - On-licence application [DOCX, 20 KB]

Form 4 - Off-licence application [DOCX, 19 KB]

Form 5 - Club licence application [DOCX, 18 KB]

Form 6 - Special licence application [DOCX, 19 KB]

Form 7 - Public notice on off and club licence [DOCX, 14 KB]

Form 8 - Public notice special licence [DOCX, 13 KB]

Form 9 - On-licence (premises that are not a conveyance) [DOCX, 15 KB]

Form 10 - Off-licence [DOCX, 16 KB]

Form 11 - Club licence [DOCX, 14 KB]

Form 12 - Special licence (premises that are not a conveyance) [DOCX, 15 KB]

Form 13 - Special licence (Conveyance) [DOCX, 15 KB]

Form 14 - Application for variation or cancellation of conditions [DOCX, 14 KB]

Form 15 - Notice of renewal of licence [DOCX, 13 KB]

Form 16 - Application for temporary authority [DOCX, 14 KB]

Form 17 - Application for manager's certificate [DOCX, 14 KB]

Form 18 - Manager's certificate [DOCX, 13 KB]

Form 19 - Application for renewal of manager's certificate [DOCX, 14 KB]

Form 20 - Notice of renewal of manager's certificate [DOCX, 13 KB]

Form 22 - Application for variation, suspension, or cancellation of special licence [DOCX, 15 KB]

Form 24 - Search warrant [DOCX, 18 KB]

Form 25 - Request to constitute licensing trust [DOCX, 13 KB]

Form 26 - Notice requesting poll of electors on completion proposal [DOCX, 12 KB]

Form 27 - Notice requesting poll of electors on amalgamation proposal (relating to licensing trusts) [DOCX, 12 KB]

Form 28 - Notice requesting poll of electors on conversion proposal [DOCX, 13 KB]

Form 29 - Notice requesting poll of electors on amalgamation proposal relating to community trusts [DOCX, 13 KB]

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