Applicationrenewal for a permit to receive concessional spirits

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					                                                     Application/renewal for a permit
                                                     to receive concessional spirits
Use this form to apply for, or renew, a permit to receive concessional spirits for approved purposes.
You do not need to complete this form if the Commissioner has made a determination that:
n you are in a class of persons that can access a limited quantity of spirits without a permit, or
n the spirits are denatured to a formula approved by the Commissioner and do not require a permit.

The determinations are available at www.ato.gov.au/excise

To complete this application
Read the fact sheet(s) Excise – concessional spirits (NAT 15388) and/or Excise – wine
fortification (NAT 15677) carefully before completing this application. If you need more                     Fax your completed form to:
information or assistance, phone the Alcohol industry group on 1300 137 290.                                   1300 130 916
Print clearly using a BLUE or BLACK pen only.                                                                or send it to:
Use BLOCK LETTERS and print one character per box, e.g.            2 0 0 4                                     Alcohol industry group
                                                                                                               GPO Box 2318
                                                                                                               ADELAIDE SA 5001
Print   X   in all appropriate boxes.



Type of application
This application is:
an initial application

             a renewal          Provide previous permit number(s)




Applicant details
Applicant name


Trading name (if applicable)




Australian business number (ABN)                                      Tax file number (TFN)
                                                              OR

    It is not compulsory to provide your ABN or TFN but it will help us process your application promptly.

Address

Suburb/town                                                                                                  State/territory   Postcode



Postal address (if the same as address above, print AS ABOVE)

Suburb/town                                                                                                  State/territory   Postcode



Business phone                                       Mobile                                             Fax (if applicable)


Business email address (if applicable)




NAT 3248-08.2006                                 IN-CONFIDENCE – when completed
Contact details
Who is the authorised contact person if we need more information about this application?

Title:     Mr    Mrs         Miss       Ms       Other
Family name


Given names


Position


Business phone                                             Mobile                                                  Fax (if applicable)


Business email address (if applicable) (If the same as previous address, print AS ABOVE)




Spirit details
Quantity of spirits required                                                                                 Place an   X   in the appropriate box.

                                                                                      litres of alcohol          per year           once only

For what purpose(s) will the spirits be used?
                             manufacturing
industrial             (including fortifying)            scientific         medical             veterinary              educational

For each purpose you have selected above describe how you will use the spirits.
If insufficient space, attach a separate sheet with the relevant details.




                                                    IN-CONFIDENCE – when completed
Licensed supplier details
SUPPLIER 1
Australian business number (ABN)
Name




Address


Suburb/town                                                                                                State/territory    Postcode


Business phone                                     Business fax (if applicable)



SUPPLIER 2
Australian business number (ABN)
Name




Address


Suburb/town                                                                                                State/territory    Postcode


Business phone                                     Business fax (if applicable)



SUPPLIER 3
Australian business number (ABN)
Name




Address


Suburb/town                                                                                                State/territory    Postcode


Business phone                                     Business fax (if applicable)



SUPPLIER 4
Australian business number (ABN)
Name




Address


Suburb/town                                                                                                State/territory    Postcode


Business phone                                     Business fax (if applicable)



If there are more than four suppliers, please attach a separate page with name and address details for each supplier.

   You should check with the relevant state authorities for any requirements regarding the use and/or storage of the high strength spirit
   sought in this application.




                                              IN-CONFIDENCE – when completed
Total number of pages submitted


Please indicate the time taken to complete this form, including getting the necessary information.                minutes




        Privacy
 The Tax Office is authorised by the Excise Act 1901 and the Excise Tariff Act 1921 to collect the information requested on this form. The
 information is used by the Tax Office, as part of the assessment process, to help us decide whether to approve your application for a permit.
 The information may be disclosed to other bodies, as authorised by law. These bodies may include agencies such as:
 n Centrelink
 n the Australian Customs Service
 n law enforcement agencies
 n the Director of Public Prosecutions, and
 n the Australian Bureau of Statistics.

 Information may also be provided to individuals or entities in relation to whether you are approved to receive concessional spirits, of a
 specified quantity, for a specified purpose.
 If the disclosure includes personal information, information principle 11.3 in section 14 of the Privacy Act 1988 limits the use to the
 purpose for which it was disclosed.


        Complaints, comments or suggestions:
 We value your complaints, comments and suggestions and we use them to improve our processes and the service we provide to you.
 If you would like to discuss any excise service or product, we invite you to phone us on 13 28 70 or send an email
 to ATO-TaxpayerComplaints@ato.gov.au




Declaration
I declare that the information provided in this application is true and correct.
Name


Position


Email


Signature


                                                                                                            Day        Month           Year

                                                                                                  Date




                                               IN-CONFIDENCE – when completed

				
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Description: Applicationrenewal for a permit to receive concessional spirits