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Application for Fish Retailer Licence or Renewal

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Submission Acknowledgement

Application for Fish Retailer Licence or Renewal
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Instructions

Application for Fish Retailer Licence or Renewal
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You can use this form to:

Apply for a Fish Retailer Licence or Renew an existing Fish Retailer Licence.

Under the Northern Territory Fisheries Act you will need a Fish Retailer Licence if you are selling fish or aquatic life to the final consumer (eg, Fish and Chip Shop, Market Stall selling a fish dish, Restaurant selling seafood meals)

Fish Retailer Licence is valid for a period of 5 years

How to complete this form

Select Application Type. If you are renewing your existing Fish Retailer Licence please enter your licence number (eg B2/1234). Please select if you are a Company/Partnership or an Individual.If you are a Company/Partnership you must nominate a natural person to be responsible for the licence.If you are an Individual you may nominate a natural person to be responsible for the licence.The trading outlet is the place where the processing and sale of fish is conducted.The trading outlet nominated person is the person responsible for conducting operations. Please enter all mandatory fields on this form.
You are not permitted to carry out any activities in relation to this application until you have been advised of the decision.

If you need assistance completing this form, please email FisheriesLicensing@nt.gov.au.

Fields marked with an asterisk (*) must be completed before your form can be processed.

Application Type

Application for Fish Retailer Licence or Renewal
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Application Type *
Are you as a... *

Individual Details

Application for Fish Retailer Licence or Renewal
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Date of Birth (DD MMM YYYY) *
Gender *

Identification

ID Type *

Residential Address

Is the mailing address same as the address above? *
Please enter at least one contact number *

Company/Partnership Details

Application for Fish Retailer Licence or Renewal
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Is the Mailing Address same as the Address above? *

Nominated Person

Application for Fish Retailer Licence or Renewal
Fields marked with * are required
Would you like to nominate a person other than yourself to be responsible for your license? *

Nominated Person Details

Date of Birth (DD MMM YYYY) *

Nominated Person Residential Address

Is the Mailing Address same as the Address above? *
Please enter at least one contact number *

Period of Nomination

Trading Outlets

Application for Fish Retailer Licence or Renewal
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Enter the details of each trading outlet. A maximum of 10 trading outlets may be entered.

Trading Outlet

Outlet Street Address
Please enter at least one contact number *

Outlet Nominated Person

Outlet Nominated Person Details
Date of Birth (DD MMM YYYY) *
Nominated Person Residential Address
Is the Mailing Address same as the Address above? *
Please enter at least one contact number *
Period of Nomination

Declaration

Application for Fish Retailer Licence or Renewal
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The must sign the form.
- I declare that the information provided in this application form is true and correct.
Northern Territory Government
Department of Primary Industry and Resources
Fisheries Division, Berrimah Farm
Goff Letts Building, Makagon Road, Berrimah NT 0828
Website: www.nt.gov.au/marine
Email: fisheries@nt.gov.au
Phone: (08) 8999 2144
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