Hospital Permit Application

Select Different Permit

This application is used by hospitals in Nova Scotia to apply for a permit to purchase and keep alcohol on the hospital site for medical purposes. Operations are to comply with the Province of Nova Scotia LIQUOR CONTROL ACT, REGULATIONS and POLICY GUIDELINES.

Please note that permits expire annually on December 31

Applicant Information

Name

Title

Address Line 1

Address Line 2

City

Postal Code

Province

Country

Primary Phone

Secondary Phone

Hospital Information

Copy Applicant Info

Hospital Name

Address Line 1

Address Line 2

City

Postal Code

Province

Country

Primary Phone

Secondary Phone

Alcohol Requirements

Yearly quantity of pure alcohol required

Quantity Litres

Usage

Yearly quantity of spirits required

Quantity Litres

Usage

Yearly quantity of wine required

Quantity Litres

Usage

Yearly quantity of beer/stout required.

Quantity Dozens

Usage

Purchasing Store

If purchasing any product from a Non-NSLC source, please provide details.

Company Name

Company Address

Company Phone

Premises Requirements

List all premises occupied by the Company (include all locations, street address, and purpose i.e. plant, warehouse, etc.) where alcohol will be used and/or stored.

Add

Name

Street Address

Purpose

Remove

Declaration Information

I understand and acknowledge that the information provided by me on this Application is true, complete and correct, to the best of my knowledge and belief. I understand that a false statement may be considered sufficient reason to withhold or cancel the issuance of my Permit(s).

I also understand that by issuance of this Permit, my responsibility and obligation to adhere to the Nova Scotia Liquor Control Act, Regulations, and Policies & Procedures as well as any special conditions and changes which may, from time to time, occur.

I declare that I am at least 19 years of age.

Check this box to accept the declaration.

Select Payment Type

The application fee can be paid by cheque, money order, cash or credit card. Cash transactions can only be made in person at the Head Office.

Credit Card

Cheque or Money Order

Cash