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Provincial Gazette Free State Province Published by Authority Provinsiale Koerant Provinsie Vrystaat Uitgegee op Gesag No. - 82 MONDAY, 27 September 2010 No. 82 MAANDAG, 27 September 2010 No. Index Page PROVINCIAL NOTICE 109 For comment: Free State Liquor Amendment Regulations, 2010 2 Gazettes are Reproduced under Government Printer's Copyright Authority No. 11386 dated 07 May 2007 www.GICS.co.za

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Page 1: Provincial Provinsiale Gazette Koerant - SAPS · 2015-10-29 · 5. Schedule 3 of the Regulations is amended by the substitution for Schedule 3 of the following Schedule..General amendments

ProvincialGazette

Free State Province

Published by Authority

ProvinsialeKoerant

Provinsie Vrystaat

Uitgegee op Gesag

No. - 82 MONDAY, 27 September 2010 No. 82 MAANDAG, 27 September 2010

No. Index Page

PROVINCIAL NOTICE

109 For comment: Free State Liquor Amendment Regulations, 2010 2

Gazettes are Reproduced under Government Printer's Copyright Authority No. 11386 dated 07 May 2007 www.GICS.co.za

Page 2: Provincial Provinsiale Gazette Koerant - SAPS · 2015-10-29 · 5. Schedule 3 of the Regulations is amended by the substitution for Schedule 3 of the following Schedule..General amendments

2

[No. 109of 2010]

NQ 82

PROVINCIAL NOTICE

PROVINCIAL GAZETTE 27 S~tcmber 2010

AMENDMENT OF THE FREE STATE UQUOR REGULATIONS) 2010

After implementing the Free State Liquor Regulations, 2010, certain issues were identified that needsreconsideration. For that reason, I) MA Dukwana, Member of the Executive Council responsible forEconomic Development) Tourism and Environmental Affaits in the Province, hereby give notice that Iintend to amend the Free State Liquor Regulations, 2010, as set out in the Schedule.

In ~etDlS of section 133(4) of the Free State Gambling and liquor Ac~ 2010 (Act No.6 of 2010)~ allinterest persons are invited to submit written comments to my office at the address set out hereunder, not·latet than 14 days from. promulgation of thisnotice:

Mr MADukwanaMEC: Tourism, Environmental and Economic. AffaitsPrivateBagX20801BLOEMFONTEIN - 930034Matkgraaff Street3rd Floot) Bojanala Building

Thl.: (051) 4004904W: (051) 4QO 4709~ [email protected]

Comments or representations received after the due date will be disregarded.

Gazettes are Reproduced under Government Printer's Copyright Authority No. 11386 dated 07 May 2007 www.GICS.co.za

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PROVINCIAL GAZEITE 27 September 2010

GENERAL EXPLANATORY NOTE:

SCHEDULE

NQ.82 3

[] Words in bold type in square bracketsindicateomissions from existing regulations.

Words underlined with a solid line indicate insertions in existingregulations.

Amendment ofRegulation 61

1. Regulation 61 of the Regulations is amendedby the substitution for Regulation 61 of the followingRegulation: .

[Reco:J:d of] (a] Appointment ofnatural person as manager

6L (1) A person other than a natural person who is the holder of a registration, and anatural person who is the holder of a registration must appoint a natural person tomanage and be.responsible for the businessand must submit information regardingthat appointment, substantially in the form of Form FSLA23 in Schedule 1 andmust-

(a) furnish in the saidForm such information as is solicited therein; and

(b) declare under oath or ttuly affirmation at the end of the said Form. that theinformation containedtherein, is true.

(2) The holder of the registradon must forthwith forward a copy of Form FSLA23 byregistered post to or bydelivery by hand to -

(a) the designatedofficeof the Authority;and

(b) the relevant designated police officer.

(3) The manager contemplatedin subrtguIation (1) 1n4Y also include an intended new. owner of the businesspen4ipg a decisionof the Authority relating to the transfer ofl~tration.".

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4 NOo82 PROVINCIAL GAZETIE ?J September 2010

Amendment of Regulation 75

2. Regulation 7S of the Regulations is amended by the substitution for Regulation 75 of the followingRegulation:

"Fees payable annually in respect of a registration certificate

75. There must, for the yeat following the yearduring which the Act comes into operation andfor ev.~r;y calendar yeat ther~~,be deposited into the account of the Authority, in respectof eachregistration certificate (excluding a specialevents'registration certificate), the annualrenewal fees set out in Part C of Schedule 3 on or before 31 December, annually: Providedthat as a tmnsitioaa} tneasme, the annual fees due at 31 Decetnber 2010 will be as set out inPut D of Schedule 3,;'.

Insertion ofRegulation 7SA

3. (1) The following Regulation is insertedafter Regulation 75:

Fees payable in respect of the conversion of licences or registration

"7SA. (1)

(2)

(3)

(4)

Fees payable in respect of the conversion of licences or registrationenvisaged itt section 142(3)(c) of the Free State Gambling and LiquorAct, 2010, ate as set out in Schedule 5 of which Part A is payable inrelation to the application submitted and Part B relates to payment forthe issuingof a registration certificate.

No application referred to in Schedule 5 may be lodged with themunicipality or Authority ot considered by the competent authority,unless the fees set out in Part A of the Schedule have been deposited intothe account of the Authority.

No amount paid in ter.tns of subregulation (2) or any part thereof mayberefunded to an applicant

Within 60 days of the issue of a registration certificate there must bedeposited into the account of the Authority the fees set out in Part B ofSclledu1e 5.".

(2) The following Regulation is insetted after Regulations 75A:

"75B. Renewal certificate

The Authority may issue a renewal certificate subst:3ntially in the fonn of FormFSLA25: Provided tha.tif such certificate is not send to or received by rr:gisttants, itdoes not exempt registrants £tom t.hett responsibilitY to pay the wgjsttation feesbefore or on 31 December. annually,".

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PROylNCIAL GAZETIB 27 Sc;ptemb<:r 2010

Amendment of Schedule 1

NO 82 5

4. Schedule 1 of the Regulations is amended by -

(a) the substitution of forms FSLA1) FSLA2, FSLA3, FSLA7, FSLA9, FSLA11, FSLA14,FSLA15, FSLA16, FSLA17, FSLA19) FSLA20 and FSLA24 of the forms attached hereto;and

(b) . the insertion of fonn FSLA 25.

Amendment of Schedule 3

5. Schedule 3 of the Regulations is amended by the substitution for Schedule 3 of the followingSchedule.

.General amendments

6. The heading «CHAPTER IX" which appears aftet Regulation 48 is substituted for "CHAPTERX".

Short title

7. These Regulations are called the Free State Liquor Amendment Regulations, 2010.

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SCHEDULE 1

FORM FSLA1APPLICATION IN TERMS OF SECTtON 27 READ WITH SECTION 31 FOR REGISTRATIONCERTIFICATE/APPLICATION FOR PERMANENT REMOVAL IN TERMS OF SECTION 41(1)

Datestamp

For official use

Amount R ..

Reference No ..

Date ..

FREESTATEGAMBLING ANDLIQUOR ACT,2010

INDEX

Description ofdocument Annexure

F

A

D

B

c

Form FSLA1(i) Application

(Ii) Building plan of thepremises approved by municipality

(III) Detailed description of external andinternal features of premises

(iv)Comprehensive written representations wIthspeclflc reference to section31(2)(a) and Regulation 70 (If It Is a permanent removal, provide alsoInformation on reasons for transfer andanyother relevant matter)

(v) Proof of notices required bysection 31(1)(d)

(Vi) Proofof payment of prescribed fee

(vli)Certified copy of the identitydocument or certified proof in the case of·trust, consortium. partnership orother legal entity

Application prepared by .

Postal address .

Telephone No .

(a) Fullnames ofappllcant. .

(b) Age ..

(e) Identity nLimber or Inthe caseofa company orclosecorporation, itsregfstration number

(d) Residential address or address of registered office .

(e) Business address andlocation of thepremises to which theapplication relates

(f) Postal address ..

(g) Business telephone number ..

{Delete (b) If applicant Is nota natural person]

.2· (8) Isapplicant -

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(I) a person who has been convicted of a contravention of thisAct or any other liquor legislation Wlthin the three yearsimmedIately preceding the dateofapplication?

(ii) a person who has been convicted, under applicablelegIslation. of an offence the elements of which areInconsistent withtheobjects and purposes of thisAct,at anytIme-

(a) after thecoming intooperation of thisAct;and

(b) withinthe threeyears Immediately preceding the date ofapplication.

Yes No

(iii) an unrehabilitated insolvent?

(b) If the applicant is a company, crose corporatfon, partnership or trust, statewhethera personcontemplated In subparagraph (s) -

(I) has a controlling Interest In such a company, closecorporation or trust

(II) is a partner in sucha partnershIp

(iii) is themain beneficiary undersuch a trust

(Marktheapplicable square)

(e) If any of the questions in subparagraphs (s) or (b) have been replied to In the affirmative,provide fUll detaIls

(Usean annexure Ifnecessary)

3 (a) Slatethenames, Identity number andaddress of eachperson, including theapplicant, whowillhaveanyfinancial interest in the business andIneachcasethe natureandextentof suchInterest [If theapplicant Isa publiC company..statutory institution or a co-Qp_EltafiYe ascontemplated In theCo-operatives Act,1981 (Act91 of 1981), Itshallbesufficient If onlythename andpostaladdress of suchcompany, statutory institution or co-operative. as thecasemaybe.thenameofeachdireotor (Ifany) thereofandthenatureandextentof the financialInterest ofsuchcompany, statlrtory Institution or co-operatlve arefurnlshed andnot alsotheInterests of Individual members o.f s..uch_company•.statutory.lnstltutlon.or-co.operative .

(Use anannexure ifnecessary)

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(b) State the financial interest in tJ1e liquor trade In theProvince of theapplicant andIf the applicantis a private company, close corporatIon, partnership or trust, alsoof every shareholder, memberor partner thereofor beneficiary thereunder. (If theapplicant or the saidshareholder, member,partner or beneficiary has no such interest. this fact must be specificallymentfoned) ..

(Use anannexure if necessary)

4 (a) State kindof registration applied for .

(b) State whatapplicant intends selling thereunderlWhat applicant Intends to manufacture

5 If applicatfon Is made for a mlcro-manufaeturer's registration for theproduction ofwineonly·

(a) Isapplicant ~

(i) a person whoengages in viticulture?

(Ii) an association of person, the majority of the members ofwhich engages Inviticulture?

(iii) a co-operafve society, whichmanufactures wine from grapesproduced by members of the co-operative society and ofwhichnoothersuchco-operative society isa member?

(b) describe the location of the premises where the liquor concerned is manufactured withreference totheart, street or !ann number .

(Delete paragraph 51fnotapplicable)(Mark theapplicable square)

6 If applfcatlon Ismadefora mlcro-manufacturer's registration -

(a) Isapplicant a person who~

(I) engages Inviticulture?

(II) manufactures anyotherfermented beverage?

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(b) descrIbe the situation of the premises where the liquor concerned is manufactured withreference to theert,street or farm number .

(Delete paragraph 6 ifnot applicable)(Mark the applicable square)

7 Underwhat nameIsthe business to becondue:ted? ..

8 (a) Describe thelocationof the premises where the business Is tobe conducted with reference totheen, street or farm number ..

(b) Inwhichmunicipality is.the premises referred to in subparagraph (a). situated?

9 Will applicant have the right to occupy the premises referred to Inparagraph 8, including such place on other premises upon whIch anyapproval is to be exercised, for the purposes of the registration appliedfor? (Mark theapplicable square)

10 In the caseof an application for an on-consumption registratIon, state In whichportionof the premisesthesale of liquorIs totake place .

11 .(a) Is appllcaUon madeinrespect of premises which·

(i) havenotyet been erected?~

No !:or

(II) arealready erected, but require additions or alterationsto make them suitable for the purposes of theproposed business?

~No ~or

(iii) are already erected and, in th~ appllcant's opinion. donot reqUire additions or alterations in order to makethemsuitable for suchpurposes?

~No

(b) If paragraph 1.1.{a)(I).or.(lI).applies•.state

(I) thedateonwhich sucherection, additions or alteratlons will be commenced with;and

(II) theperiod which willbe required fortheerection. additions or alterations

12 In thecase ofa club liquor registration. attach a copy of therules of theclUb, certified bythe president,chairman orsecretary thereof

Annaxure ..

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I declareltruly affirmthatthe infor~at.ion furnished in thisapplication andin thedocuments attached to it, istrue.

Date ..Signature of applicant or person authorized tosign applIcation

I certifythatthisdeclaration hasbeensignedandsworntolafflnned before meat this.........................................day of by the applicant/person authorizedto signapplication whoacknowledged that-

(I) he/she knows and understands thecontents of thisdeclaration:

(II). helshehasno,objection to takingthe prescribed oath/affirmation: and

(iii) he/she considers the prescribed oathto be binding on hislherconscience.

andthathe/she uttered the following words:

'I swearthat thecontents of this declaration aretrue, so helpmeGod'.fI truly'affirmthat thecootents ofthisdeclaration are true'.

Commissioner ofOaths

Fullnames ..

Business address ..

Designation ..

Mea forwhich appointment is held ..

OfficeheldIfappoIntment Is ex officio••..........................................................................................................

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FORMFSLA2NOTICEOF INTENTION TO APPLY IN TERMSOF SECTION27 READWITHSECTION 31 FORREGISTRATION

FREE STATE GAMBLING AND UQUORACT. 2010

Noticeis herebygiventhat .........................................................intends to lodgean application on •...••••.••••.•••.•••.••..••••, partIcUlars of which appear hereunder.

1 2 3 4 5 6Address of designated Fullnames,streetand postal Kindof registration Kindof product to be Nameunderwhichbusiness Nameof. nature ofanddis1ance toofficeof the Freestate address of applicant and identityno. applied for sold/manufactured is to be conducted andfull institutions of learning, similarregisteredGambling and Liquor or registration no. address of premIses . premises andplaces ofworship

Authority in the areaof therelevant district mWlicipality

Any person may. within 21 days from (date of publication In Provincial Gazstt8) lodge in terms of section 33 of the Free State Gambling and

LiquorAct, 2010an objection in writing to the FreeState UquorAuthority (address set out hereunder). The objection mustclearty indlcate the full names, identity number. residential

address. postaladdress and telephone number, if any, and where applicable. its registration numberand address of its office, of the objector. The objection mustalso identify the

application to whichIt relates. -The appUcation maybe inspected at the designated offices of the Authority duringtheirofficehours. Theaddress ofthe designated officeof theFree

StateGambling andLiquorAuthority Is:

Place••••...••...•....•..•.•••.•...•.•••....•.•......•••.....Signature ofapp1ica~torperson authorized to sign application

Oate ~••••..•..•.•.•

Footnote:Completecolumns asfotlows:(1) Relevant desIgnated officeof the Freestate Gambling and UquorAuthority.

(2) Column1.-state the local municipality Inwhichthe premises are situated.

(3) Column2.-state surnameof applicantfollowedby his or her fuU firstname.residential. business and postaladdress and identllynumber. If !he applicant is nota natural person. state thefull namesof suchperson. followed by the addressof its registered offICe and registration number.

(4)

(5)

(6)

(7)

cotemn 3.-stale the kindof registration apptied for with due regard to section46, and in thecaseOfsorghumbeerregistration, statewhetherit is intemied to sell liquorforconsumption on or off thepremises.

Column4.-statekindof productto be soIdImanufactured.

Column5.-State the nameunderwhichbuslness is to be conductedand describe thesituation of the premises wherethe business is tobe conducted withreference to lhs erf.streetor farmnumber.inclUding suchplaceon other premises uponwhich any approvalis to be exerc1sed.

COrumn 5.-Statethe nameof, natureof and distance to institutions of leaming. similarregistered premises andplacesof worship within500meterfromthe premises.

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FORMFSLA3REGISTRATION CERTIFICATE

Reference No .

FREESTATEGAMBl.ING ANDLIQUOR ACT,2010

....................................................................................................................................REGISTRATION

..........................................................is hereby registered tosell/manufacture- ..

(statekindof pr~uct) 'and, to'concfuet under thename of.., ~ : ; .

upon premises. theplan ofwhichhasbeen approved, situated at.. .

.... lnthe local municipality of ..such business as is, in accordance with the conditions set out in terms of the Act or any other law.authorized to beconducted undertheabovementioned registration.

This registration shall be subject to the condiUons determined by the Free state Gambling and Liquor

Authority in terms of theFreeState Gambling and Liquor Act, 2010, aswell8S conditions contained Insaid

Act Theconditions determined aresetout InAnnexure hereto.

Liquor notrequired for immediate sale. shall bestored ontheregistered premises.

This registratIon shall beof no forceandeffect unless theprescribed registration feeshavebeen paidintothe bank account of theFreeState Gambling and Liquor Authority andproofthereofhasbeensubmitted tothe FreeState Gambling and UquorA~ority. Payment of the prescribed fees is to be made within sixtydaysaftertheundennentioned dateof Issue.

Dateof Issue Prescribedfees

PersonactingunderpoweroftheFreeStateGambling andUquor Authority

Dste

Delete partwhich isnotapplicable

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FORMFSLA7APPROVAL TO VARYCONDITIONS OF REGISTRATION

FREE STATE GAMBLING AND LIQUORACT, 2010

DATE: REFERENCE NO .

Approval Is granted to (registrant) to vary conditions ofregistration in respect of

The newconditions of registration are attached hereto as Annexure ..

ON BEHALF OFFREE STATEGAMBLING AND LIQUOR AUTHQRITY

Date

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FORM FSLA9APPROVAL TO EFFECT STRUCTURAL ALTERNATiONS OR EXTENSION OF REGISTERED

PREMISES

FREE STATE GAMBLING AND LIQUOR ACT, 2010

DATE .. REFERENCE NO ..

Approval is granted to (registrant) to effect structuralalterations to registered premises Jextend the registered prernlses" In respect of

The structural alterations to J extension- of the registered premises that are approved is

attached hereto as Annexure '" .

ON BEHALF OF FREE STATE GAMBLING AND LIQUOR AUTHORITY

Date

De/ete partwhich Isnotapplicable

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FORM FSLA11APPROVAL IN TERMS OF SECTION 39 FOR THE TRANSFER OF REGISTRATION

DATE REFERENCE NO .

FREESTATE GAMBLING ANDLIQUOR ACT,2010

The registration certificate, heldby , ..

I" respect of premises situatedat. ..

in the local municipality of , under which business Is

conducted under the name of : Ishereby

transferred to .

Thebusiness will Infuture beconducted under the name of .

Thisregistration shallbe of no force andeffectunless theprescribed registration feeshavebeen paid intothe bank account of the Free StateGambling and Liquor Authority andproofthereofhasbeensubmitted tothe Free State Gambling and Lfquor Authority. payment of the prescribed fees is to bemadewithinsixtydays aftertheundermentloned dateof Issue.

Dateoflssue Prescribedfees P able on or before

ONBEHALF OF FREE STATE GAMBLING AND LIQUOR AUTHORITY

Date

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FORM FSLA14APPROVAL IN TERMS OF SECTION 40(3) FOR THE APPOINTMENT OF A PERSON TO CONDUCT

REGISTERED ACTIVITIES PENDING APPOINTMENT OF ADMINISTRATOR

Reference No ..

FREESTATEGAMBLING ANDLIQUOR ACT, 2010

Approval is granted that the registration in respect of premises sItuated

at. and upon which business is conducted under the name

of , Is hereby temporarily transferred to

........................................................................................................................ (name of person)

Theappointment Is permitted for the period ..

The determinatlons, consent, approvals and authorities which have been granted are set out In

Annexure(s) hereto.

This approval shall be subject to the conditions detennined by the Free State Gambling and Liquor

Authority - in terms of the Free Slate Gambling and Uquor Act, 2010 as set out in

Annexure andanycondHlons setoutinsaidAct.

ON BEHALF OF FREE STATE GAMBLING AND LIQUOR AUTHORITY

Date

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FORM FSLA15NOTICEOF INTENTION TO APPLV IN TERMS OF SECTION 41(2) FOR THE TEMPORARY REMOVAL

OF REGISTRATION

FREE STATE GAMBLING AND LIQUOR ACT.2010

Notice Is hereby given that ........................................................ intends to lodgean application for temporary removal 0registration, particulars of whichappearhereunder, with the Free State Gambling andLiquorAuthority:

1 2 3 4 5 6Address of Full names, street Kind of registration Kind of product to be Fulladdress of Nameunder which

designated office of andpostaladdress 10betransferred sold/manufactured registered premises business is to bethe Free State of applicant andlocal conducted andfull

Gambling andLiquor munIcipality Inwhich address ofotherAuthority Inthearea situated premises

of tM relavantdistrict munlcloalitv

Anyperson may JocIge an objectIon within 21 days from , , (dateofpublication in Provincial Gazette) in writing to theFree StateGambling and LiquorAuthority. Theobjectionmust clearly indicate the full names. Identity number, residential address, postal address and telephonenumber, If any. andwhereapplicable. its registration number endaddress of its office,of the objector. Theobjection must also Identify the application to which It relates. The application may be inspected at theoffices of theFreeStateGambling andLiquorAuthority during itsoffice hours at thefollowing address:

Objections mustbesubmftted to:

Place .SIgnature of applIcant or person authorIzed tosign application

Date .

Footnote:

Complete columns as follows:

(i) Column 1.-8tate surname of applicant followed by his or her full first names, residential,business and postaladdress. If applicant Is not a natural person, stale the full names of suchperson follOWed bythe address or Its registered office.

(II) Column 2.·Statethe kindof registration to be removed withdue regard to section 42, andin thecase of a scxghum beer license, state whether liquor Is sold for consumption on or off theregistered premiaes.

(iii) Column 3.-8tatethe kindof product tobesold/manufactured.

(iv) C_otumn 4.-Descrlbe the situation of the premises where the registered business is conductedwith reference to the 00, street or farm number andstate the local municlpalily in which it issituated.

(v) Column 5.·State the nameunderwhich business Isto be conducted anddescribe the situationof the premises wherethe business Is to be conducted with reference to the ert,streetor farmnumber, including suchplaceonother premiSes upon which anyapproval or detennination is tobeexercised.

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FORM FSlA16APPLICATION IN TERMS OF SECTION 43 FORTHE TEMPORARY REMOVAL OF REGISTRATION

Datestamp

For official US&

Amount R ..

Reference No , .

Date ..

FREESTATEGAMBUNGAND LIQUORACT,2010

INDEX

Description ofdocument

(I) Application

(II) Plan of thepremises

(III) Descripflon of thepremises

(iv)Comprehensive written representatlons

(v) Proofofnotices required byRegulatIon 43(2)

(vi)Proofof payment of prescribed fees

Annexure

Form FSLA16

A

B

C

oE

Application prepared by .

Posta\ address , .

Telephone no .

1 Full names ofappficant. ..

21f applicant isnota natural person, state thenames, Identity number andaddress ofeachshareholder,

member. partner or beneficiary .

3 (a) Under whatname is the registered business conducted? .

(b) (i) Willthename change asa resutt oftheremoval?

(MarJ\appllcab1e"·~fquare)

{ill Ifso,statenewname ..

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4 (a) Describe the situation of the premises where the registered business Is conducted withreference to the ert, streetor farmnumber

(b) Describe the situation of thepremises where thebusiness Is tobeconducted with reference totheert,slreetor farmnumber

5 (a) Are the premises referred to In paragraph 4(8) and (b) in the samemunicIpality?(Mark theapplicable square)

(b) State the shortest distance by road from the premises referred to in paragraph 4(8) to thepremises referred to tn paragraph 4(b) ..

6 In the case of a micro-manufacturer-s registration (orthe production ofwine only, describe thesituationof the premises where the liquorconcerned is manufactured with reference to the ert, street or farmnumber ..

7 In the case of a producer's registraUon, descrIbe the situation of the premises where the liquorconcerned ismanufactured with reference totheert,street or farmnumber .

8 WJII applicant have the right to occupy the premises referred to inparagraph 4(b), inclUding such placeon other premises upon whIch anyapproval or detannlnation Is to be exercised, for the purposes of theregistration?

(Mark the applicable square)

Yes

9 In the case of an application for the temporary removal of an on-consumption registration, state inwhich portion of the premises thesaleof liquor Isto takeplace ..

10 (a) Isapplication madeIn respect of premises whIch·

(i) havenotyetbeen erected? ~:or

(II) areaJready erected, butrequire additions or alterationsto make them suitable for the purposes of theproposed business?

~(m) are already erected and, In the applicant's opinion, do

not require additions or alterations In order to makethemsuitable for suchpurposes? '

~Jor

(b) If paragraph 10(a)(i) or (II)applies. stete-

(I) the date on which such erection. addltfons. or alterations will be commencedwith : : and

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(II) the periodwhichwlIIbe required for theerection. additions or alterations ..

......., , , .11 Statefor whatperiodsuchremoval Isdesired ..

• ill "" , .. """."""" .. " .. " " ~ .. "". "" .. " •• ",. "." • " ,." " " .. """" .. t' "".."" I'" ,. II """ " It"." " f , " "" .. " , .. , " Ill." "" .. " ,. " "" , .. , ,. .

I declare/truly affirmthat the Information furnished Inthisapplication and in the documents attached to it, istrue.

Date .SIgnature of applIcant or person authorized to

. sign applicationI certifythat this declaration hasbeensignedandswornto/affirmed before me at ..this day of by theapplicant Jperson authorized tosIgnapplicatIon Who acknowledged that-

(I) he/she knowsand understands the contents of thisdeclaration;

(II) he/shehasno objection to taking the prescribed oath/affirmation; and

(ill) he/she considers the prescribed oathto be binding onhislherconscIence,

And thathe/she uttered the following words:

tl swear thatthe contents of this declaration are true, so help me God'.fI truly affirmthat the contentsofthisdeclaration are truet

Commissioner ofOaths

Full names ..Business address .

Designation .

Areafol'whichappointment Is held .

OfficeheldIfappointment Is ex officio ~ ~ .

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FORM FSLA17APPROVAL FOR TEMPORARY REMOVAL IN TERMS OF SECTION 41 OF REGISTRATION

Reference No ..

FREESTATEGAMBUNG ANDLIQUOR ACT,2010

The reglstration granted In respect of premises situated

at and upon which business is conducted under the name

of.................. is hereby temporarily removed to premises situated

at ; .In the local municipality of where

business will be conducted under the name of

Thetemporary removal Ispermitted for theperiod ..

The determinations, consent, approvals and 8uthorlUes which have been granted are set out In

~nnexure(s) hereto.

This approval shall be SUbject to the conditions determined by the Free Slate Gambling and Uquor

Authority ln- terma of the Free State Gambtlng and Liquor Act. 2010 as set out In

Annexure a.ndanyconditions setoutInsaidAct.

Liquor-not required for Immediate saleshall bestored on the registered premises/at a place Indicated in

Annexure hereto.

Thisregistration shallbe of no force andeffectun1ess the prescribed registration fees havebeen paid intothebankaccount of the FreeStateGambl!ng andliquorAuthority andproofthereof hasbeen submitted tothe FreeState Gambling and Uquor Authority. Payment of the presoribed fees Is to be made within sixtydays afterthe undermentloned dateof Issue. .

Date of Issue Prescribed fees

I(lNBEHALFOF FREE STATEGAMBLING ANDLIQUOR AUTHORITY

I~t~· ..······.... ··.. ····:·..·· ....·· ..·....··..·....I

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FORM FSLA19REGISTRATION CERTIFICATE: MICRO-MANUFACTURER OR AUTHORISED DEALER OF

METHYLATEDSPIRITS

Reference No .

FREESTATEGAMBLING AND LIQUOR ACT, 2010

....................................................................................................................................REGISTRATION

..•••• ~ ~••. ~ Is hereby registered tosell/manufacture methylated spirits andto

conduct underthenameof .

Upon premises, theplanof whIch hasbeenapproved. situated at ..

•• ...Inthelocalmunicipality of .such business 8S is, in accordance with the conditions set out in terms of the Act or any other law,authorized to beconducted undertheabovementIoned regIstration.

The determinations, consent, approvals and authorities which have been granted are set out in

Annexure(s) hereto.

This registration shall be subject to the conditions determIned by the Free State Gambling and Liquor

AuthorityIn tennsof the FreeState Gambling and Liquor Act,2010, aswellasconditions contained in said

Act. ThecondUions determined aresetout InAnnexure hereto.

thIs registration shall beof no force ~nd effectunless the prescribed registration fees havebeenpaid intothebankaccount of the FreeState Gambling andLiquor Authority andproofthereofhasbeen submitted tothe Freestate Gambling and UquorAuthority. Payment of the prescribed fees is to be madewithinsixtydays aftertheunder~entioned dateof fssue.

Date of Issue

..... , •• I " , ~ , ••• 4141'" , " ,,, " ••

Prescribed fees

Personacting underpower of the FreeStateGamblingandLiquor Author/ty

Date

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FORM FSLA20COMPLIANCENOTice

FREE STATE GAMBLING ANDLIQUOR ACT.2010

DATE .

TO:

REFERE~CE NO .

1. Please take notice that the inspector/police officer named below states that you havefailedto comply withthe following provisions of the Free State Gambling andLiquorAct. 2010andIts regulations as set outon attached sheet (Annexure ).

2. The particulars of your failure to comply are as set out on the attached sheet (Annexure...................).

3. You are hereby required to take the actions, or cease the actions. set out in the attached. sheet, within thetimespeclfled In respect of each ofthem(Annexure .•........•.•...•..).

4. Failure tocomply with this notice mayresult Inanyoneor more of the following penaltIes:

4.1Prosecutlon In termsof sectIon 128(2)(9) of the Free State Gambling and LiquorAct. 20101

for.the offence of failure to comply withthisnotice. for which the penalty uponconvJction is afineor imprisonment fora termnotexceeding 10yearsl or to botha flne andimprisonment.

4.2Prosecutlon for an offence in terms of section 128of the Free State Gambling and LiquorAct,':2010, for which the penalty upon conviction is a fine or imprisonment for a term notexceeding 10years, or to botha fineandImprisonment.

4.3Cancellation of your registration held under registration number forfailure to comply with this notice. In terms of section 42 of the Free State Gambling andLiquorAct,2010.

NAME OFLIQUOR INSPECTOR OR POLICE OFFICER

Date

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FORM FSLA24INSPECTORtS CERTIFICATE

FREE STATE GAMBLING AND LIQUOR ACT, 2010

DATE .. REFERENCE NO ..

TheFreeState Gambling and LiquorAuthority responsible for Economic Affairs herebyappoints

to be an Inspector for the purposes of the Free State Gambling and LIquor Act. 2010, to investigatecomplaints in terms of the Act, to monitor and enforce compliance with the Act. and to perform anyother functions and exercise any other powers conferred on an Inspector in terms of the Free StateGambling andLiquor Act,2010.

MEC responsible for Gambling and LIquor Matters

Date

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FORMFSLA25

RENEWAl CERTIFICATE

RegistratIon No.: _

fREE STATE GAMBLINGAND LIQUORACT, 2010

BANK ACCOUNT OF AUTHORITY:

Bank Name: _

Branch Code:, _

AccountNo.: __

ADVICE OF ANNUAL REGISTRATION FEES PAYABLE IN RESPECTOF

A LIQUOR LICENCE FORJIiiE YEAR ""'20=-- __/' -

r-::N~A::-::M=E:--:O~F~TH~E=--:::R=E=G':"::IS=T=-RAN":"":"":"T~A"':":N=D~PO~S=T:-:'A'="'"1L r-::N~A:-::M~E~--:A:-:-:N:-::::D--:-A-=D-=D'::'R~ES~S=--~O::-:F=--~L~IC::-=E=-:-N~S'=ED~

ADDRESS: PREMISES:

Kind of licence

FOROFFICIALUSE BY FIRST NATIONAL BANK

Fees payable

Note: The fees mustbe paidbefore or on 31 December, annually. Latepayments are not allowed Interms of the FreeState Gambling and Liquor Act, registration lapse If payments are not madebefore oron 31 December

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SCHEDULE 2FEES PAYABLE IN RESPECT OF APPliCATIONS

Part A PartBNature of application Pees payable

R

AppliC1\tion in termsof section 27 read with section 31 for regiattation (excluding a specialevent andmethylated spiritsregistration):

- Accommodation establishment, except~esthouse 1000- Ac:comsnodation establishment: Guesthcusc 1000

· . Restaurant 2500.. Club 1500- Tavern 1500· NiabtClub 2000

· GattIbb establishment . ... .. ·3000- Liquor store 2500- Grocer's wine 2500- Miao-manu&cturln2 oflkluor 2500

Application in termsof section54 for special eventsreaistration 1000Application in termsof section37 for variation of conditions of rep;lstration 500Application in termsof ~tiOI1 38 foealteration or atension of l'e«istered premises 500Application in termsof section39(3)to procure I COdtrolling inte.te9t in the business 500to which there~tion .relatesA1>DUcation in tenns of section39 or 41 COt the uansferor removal of relristmtion:

· Accommodationestablishment 788

- Restaurant 750- Oub 750

· Tavem 625

· N.i2htClub 1250- Gamblina eShlblishment 1250

· ~uotsto.re 750- Grocer's wine 375

· Micro-manufacturin2' of liquor 1250Application in terms of section 40(3) for the appointment of fl person to conduct 500te~tel:ed activities1)eodin2213J)OintmentofAdministtatotApplication in terms of section 21(2) for registration 2S micto-manu&.e:turer of 750methylated lJI)irits .Application in tenn8 of section 27(2) fot registcation as auth0ri2ed dealer of 750methylated epirltsAppliation in teans of .regulation 61 of a natural person to manage and be 500resl'Onsible for thebusiness to which the remstratlon relates

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SCHEDULE 3FEES PAYABLE IN RESPECT OF REGISTRATION CERTIFICATES

Re2'isuanol1 PlUtA PartB **Part C PanDFees payable in Pees payable in Annual Annualrespect of a new respect of the tegi8tration fees rcgisuatioD lees

regisuatioD transfer of a 2010/2011leptnnon

R R R RAccommodation C$tablishment; 8000 1500 3500 3500exceptRUcsthouseAccommodation establishment: 8000 1250 5000 5000GuesthouseRestaunnt 15000 1000 3000 3000Club 10000 1000 3000 3000Ta.vem 10000 1000 25QO *Rural SOp

*Uxban 750N~tClub 12000 . 1000 5000 5000Gamblin.ll establishment 20000 2000 10000 5000Liquot store/autho.tized dealer of 15000 1000 3000 3000methylated spiritsG.cocec'9 wiae 15000 1000 SOOO SOOOMicro-llWWucturiag of 15000 1250 5000 5000HCluor/methvlted spiritsSpeci2l events registration 1000+ N/A N/A N/A

250perdayo{event

lid'Urban" when referred to in Part D of Schedule 3 means Bloemfontein) Welkom, Sasolburg,Bethlehem and Kroonstad

*"Rural·· when referred to in Part D of Schedule 3 means all other areas in the Free State: Provinceexcluding those referred to as "Urban"

*In an instancewhere it is uncertain whether a liquor registration falls within a rural or an urbanarea,the CEO of the Authorityhas the powerto decidein which area the registrationmust fall

**Will be reviewed

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SCHEDULE 4TIMES OF BUSINESS

Type of business Business hours Business days duringweek

Accommodation establishment 10:00 - 00:00 Monday to Sunday

Restaurant 10:00 - 00:00 Monday to Sunday

Tavern 10:00 - 02:00 Monday to Sunday

Club 10:00 - 22:00 ... Monday to Sunday

Nightclub 18:00 - 04:00 Monday to Sunday

Gambling establishment 10:00 - 04:00 ," Monday to Sunday(excluclil12 casino)

Casino 08:00 - 06:00 Monday to Sunday

Special event Asdetetmined in registration ~ determined ineel'tif'icate rea-istration certificate

Liquor store: Monday to Saturday

(a) Wholesale 09:00-19:00

(b) Other liquor store 09:00-19:00

Grocertswine 08:00- 20:00 Monday to Saturday

SCHEDULESCONVERSION OF LICENCE

Part A PartBR R

Application for conversion 500 500

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