If this is your first year registering, please supply Registry of Joint Stock Companies registration information.
Please complete the relevant information
Names of Officers, Directors and/or Shareholders and Holding Companies, if any
Please select the Permit Type(s) you wish to apply for:
Does the Agency or its owners have any relationship or association, financially or otherwise, with a liquor licensed establishment, Agency Store, Private Wine & Specialty Store or the NSLC?
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.
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 my registration.
I 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 acknowledge and accept that the NSLC may choose to disseminate contact information contained here for business purposes.
My signature below indicates I understand and acknowledge that the Agency named in this application accepts full responsibility for its sales representatives and demonstrators for the NSLC In-Store Customer Tasting Program and has fully trained all participants involved in the tasting (demonstrators & representatives) on the NSLC’s In-Store Customer Tasting Policy & Guidelines.
I declare that I am at least 19 years of age.
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.
