Late payment fee waiver application

2024 Annual Liquor Licence Fee - Late Payment Fee Waiver Application

What this form is for?

To apply for a waiver of the late payment fee on the grounds of exceptional circumstances.

Who can lodge this form?

You can lodge this form if you are:

a licensee
an approved manager
a contact person
an authorised legal representative.

What you will need:

Your liquor license details
Your personal and contact details
You need to provide supporting documents that support why the late payment fee should be waived. These may include:
- A copy of your receipt for payment if you paid on time.
- A business activity statement to demonstrate your financial hardship.
Please complete and attach an authorisation consent letter if you are not listed as a licensee, approved manager or contact person on your liquor licence document.

More information

Make sure you take your time filling out this application correctly. You will not be able to make changes once the application is submitted.
If information is missing, processing this form will be delayed and the application may be refused.
After submitting your application, you will be sent an email confirmation with a copy of your application. This will be sent to the email you provided on the form.
If you do not receive an email confirmation, your application may not have been submitted. Please contact us to check.

Key dates

Lodge this form by 25 July 2024. Applications received after this date will not be processed.

Cost:

There is no fee for this application.

Need more information?

Visit: https://www.liquorandgaming.nsw.gov.au/contact-us

Call: 1300 024 720

Liquor licence (as per licence document) and applicant details:

Red * marked as mandatory field

1. Licence number (LIQ): *

2. Licence name: *

3. Premises address: *

4. Applicant type: * Multiple can be selected

Licensee (as per licence document)
Approved manager (as per licence document)
Contact person (as per licence document)
Authorised legal representative
Other

5. If Applicant type is other, please specify:

Applicant details

6. Given name: *

7. Surname: *

8. Applicant phone/mobile: *

9. Applicant email: *

Late Payment Fee Waiver Request

Tell us why you are requesting a waiver of the late payment fee.

10. Did you pay your annual liquor licence fee in full by the due date 29 May 2024? *

Yes
No

11. If yes, please attach a copy of your receipt You can attach your file here. This can be a pdf, word, jpg or png file. 2MB is the maximum file size.

12. Please provide reasons why you didn't pay your annual liquor licence fee by the due date:

13. Please provide reasons supporting your request to have the late fee waived: *

14. Attach supporting documents: These can be pdf, word, excel, jpg or png files. 3MB is the maximum file size. You can attach up to 10 files.

15. Have you already submitted other applications related to your annual liquor license fee?

Yes
No

16. If yes, provide information about your application:

Declaration

I declare the contents of this application, including attachments, are true, correct and complete and I have made all reasonable enquiries to obtain the information required to complete the application.
I will immediately notify Liquor & Gaming NSW (L&GNSW) if the information changes before the application is determined.
I acknowledge that it is an offence to provide false, misleading or incomplete information in this application under section 36 of the Gaming and Liquor Administration Act 2007 and section 307A of the Crimes Act 1900.
I acknowledge that failure to provide all required information may result in delay or refusal of this application.
I understand that specific details I have supplied in this application may be 'personal information' under the Privacy and Personal Information Protection Act 1998. Personal information is any information or opinion that identifies an individual, or enables someone to identify an individual.
I acknowledge that L&GNSW is collecting information to enable processing of the application. I also understand that L&GNSW will use the information for its intended purpose only, store the information securely, and allow the applicant or licensee to access and update the information. When processing this submission, L&GNSW may need to disclose information to other Government agencies.
I understand that L&GNSW may use information provided in the application to inform further inquiries to ensure compliance with regulatory obligations.

17. Authorise *

I am authorised to make this application and by providing my name in the below field, I make the above declaration and acknowledgements;

Details of the person making the above declaration

18. First name: *

19. Last name: *

Please attach an authorisation consent letter here if you are not listed as a licensee, approved manager or contact person on the liquor licence document.

20. Authorisation consent letter: These can be pdf, word, excel, jpg or png files. 2MB is the maximum file size. You can attach up to 10 files.

You cannot edit this application once you submit.

A copy of your responses will be emailed to the email address you provided.