Dutiable Commodities (Liquor) Regulations
FORM 5
Club Liquor Licence
No.
Name of club
Name of *secretary/person nominated under regulation 26
[CAP. 109
B11
[Subsidiary]
[reg. 26.]
Address of club
Period of licence, from
Fee $
to
Licence is hereby granted for the supply of intoxicating liquors to the members of the club, at the premises and for the period specified above on the following conditions-
(conditions to be inserted)
Date
* Delete whichever is inapplicable.
19
R
Secretary to the Board