OFFICIAL − Sensitive
Special retail application
Under what category of special retail shop do you wish to apply for this certificate? (as prescribed in the Retail Trading Hours Regulations 1988)
Motor vehicle spare parts shops
Shops at sports venues
Art and craft shops
Hardware and home improvement shops
Pharmacies
Shops at international standard hotels
Boating shops
Souvenir and duty free shops
Video shops
Garden nurseries
News agencies and bookshops
Applicant information
Applicant type
Individual/sole trader
Company (body corporate)-To apply on behalf of a company, you must be a director, shareholder or secretary of the company, or be authorised to act on behalf of the company
Partnership
Applicant name (full name of the individual/sole trader, company or partnership applying for the special retail shop certificate)
Applicant contact
Phone*
Mobile
Email*
Other
Registered trading name and location
The retail shop above is/will be trading under the registered trading name of
Shop address*
Suburb/Postcode*
State
Is this business currently operating?*
Yes
No
Date of commencement of operations
Postal address*
Suburb/Postcode*
State
Declaration
Only goods and services or both that are prescribed in relation to a special retail shop of the category selected are sold or provided at the retail shop
I am authorised to make this application as the applicant or member of the applicant group
The information provided in this application is correct, to the best of my knowledge
Privacy Collection Notice

Consumer Protection is a division of the Department of Local Government, Industry Regulation and Safety (LGIRS), and collects your personal information to:

  • Process your application for a special retail shop certificate; and
  • Maintain records of applications, for accountability and reporting purposes.

We may provide this information to:

  • Internal staff to enable the processing and administration of your application.

We will not disclose personal information about you to anybody else, unless you have given consent, or we are authorised or required to do so by law.

Providing the requested information forms part of an application for a special retail shop certificate as required by section 11 of the Retail Trading Hours Act 1987 and associated Regulations. If you choose not to provide it, we will be unable to process your application or issue a certificate.

Please see LGIRS Privacy Policy on our website for more information about how we handle your personal information, how you can request access to, or correction of, the personal information we hold about you, and who to contact if you have a privacy enquiry or complaint.

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