Matamata-Piako District Council

Section A - Applicant Details

Note: Consents are specific to the venue and cannot be held by an individual or group.

The following applies to my application (please tick)*

Application for a new venue consent to host gaming machines

A venue with existing gaming machines applying to increase the number

A venue which holds an existing class 4 consent applying to relocate

Two or more clubs applying to merge

Application for TAB Venue Consent

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Name of Applicant*

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Name of Contact Person*

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Name of Corporate Society/Club*

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Postal Address for Correspondence*

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Email:*

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Phone Number*

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Preferred method of contact

Phone

Email

Post

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Section B - Venue Details

Are you operating a venue established prior to 17 October 2001 that has continuously held a licence since that date?*

Yes

No

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Note:

Class 4 gaming machine venues established on or before 17 October 2001 may operate a maximum of 18 gaming machines. Venues require Council consent to increase the number of gaming machines that they operate.
Class 4 gaming machine venues established after 17 October 2001 may operate a maximum of nine machines and require Council consent to operate any at all.

Name of Venue*

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Street Address of Venue*

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Full Legal Description*

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Names of Owner and Management Staff

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Primary activity of venue (please select)*

For private club activities

For the sale of liquor for consumption on the premises

For TAB venues as defined by section 5 of the Racing Industry Act 2020

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Details of liquor licence applicable to the venue including restricted area

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Number of approved existing gaming machines and the number of new or additional gaming machines proposed

Current

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Proposed

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If applying to relocate or merge, name of venue and street address of where relocating/merging*

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Reason(s) for relocation/merge

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Section C - Supporting Information

Declaration

By signing this declaration, I agree that:

I will pay the deposit amount as listed in the Fees and Charges 202526 as per the Local Government Act.

I hold the appropriate authority to submit this application and that the information supplied here is true and correct.

I understand and agree that my contact details and all other information included with this application may be presented to the Hearings Commission in a public hearing and will be made accessible to the public.

Name*

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Date*

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The name, email & phone number (and physical address if supplied) information requested as part of this application process is to ensure

We link the application to the correct person
That we have enough details to identify and contact the person if necessary to complete the application process.

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Our Services

Application for Class 4 Gambling Venue/TAB Venue Consent

Section A - Applicant Details

Section B - Venue Details

Section C - Supporting Information

Declaration