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A-383 Form 5 Special Licence Application

Form 5 (Liquor Regulations)

Application for Special Licence (New and Renewal)

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Special Licence Application (New and Renewal)
New or Renewal Application
Licence Holder Information
Establishment Information
Licensed Hours Requested (new applications) or Current Licensed Hours (renewals) (this form cannot be used to a request a change to licensed hours)
New Applications Only
(the following are attached to this application)
Renewals Only
(the following are attached to this application)

I declare that the information provided in this application is true to the best of my knowledge. I understand that, if any of the information provided is found to be false, the licence may be revoked immediately.

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