Tobacco Affidavit

You need to compile a Tobacco Affidavit, in Compliance with Tobacco Control Amended Act No 12 of 1999. Affidavit to Comply with Legislation.

SAMPLE ONLY of Tobacco Affidavit – Applicant must do site specific affidavit.

STATEMENT IN TERMS OF THE TOBACCO PRODUCTION CONTROL AMENDMENT ACT, 1999

(ACT NO.12 OF 1999)

Tobacco Affidavit
Tobacco Affidavit

AND

LIST OF:-EDUCATIONAL INSTITUTIONS, PLACE OF WORSHIP OR SIMILAR LICENSE

WITHIN A RADIUS OF (1) ONE KILOMETER FROM THE NEW PROPOSED PREMISES

I, (Name of Applicant), states under oath:

I am an adult male/female with ID: __________, residing at: (Residential Address of Applicant). I am the appointed director / member / sole owner of (Name of Applicant or Business Entity) on behalf of (Business Name) with 100% Shares.

The company has applied for the granting of a liquor store license (On-Consumption / Off-Consumption), alternatively such license that the board, in its discretion, will deem appropriate in terms of Section 23 of the Gauteng Liquor Act, (Act No. 12 of 2003) in respect of (Name of Business), (Full Address of Premises, Including ERF Number as per Zoning Certificate) (NO PRIVATE RESIDENCE).

The premises will be a NON-SMOKING PREMISES and thereof comply with the Tobacco Products Control Amendment Act, 1999 (Act No.12 of 1999). The premises will be adequately furnished and equipped to comply with the Tobacco Products Control Amendment Act ,1999 (Act No.12 of 1999) and that the necessary notice have been placed on strategic points within the premises to indicate that the premises will be a non-smoking premises.

To the best of the applicant knowledge, the following Educational Institutions are with a radius of 500m: (Names of Educational Institutions if any or NONE).

To the best of the applicant knowledge the following Places of Worship / Churches within a radius of 500m: (Names of Places of Worship or Churches if any or NONE).

To the best of the applicant knowledge, there are (Names of Similar Licensed Premises or NONE) Similar Licensed Premises within a radius of 500 metres from the premises.

A copy of the notice recording the lodging of this application will be affixed to the premises as required in terms of section 24(1) of the Gauteng Liquor Act No.2 of 2003

This notice will be affixed by not later than (Date of Placement of Public Notice at Premises) and I will ensure that the notice remains in place for not less than twenty-one (21) days from the date of lodgement of the application with the secretary of the local committee.

I understand the contents of this statement

I have no objections in taking the prescribed oath to be binding of my conscience

Date………………….

I certify that this declaration has been signed and sworn to before me at ……………………………………… this ………day of ………………….month ………………year by the applicant who acknowledge that

  1. He knows and understands the contents of this declaration,
  2. He has no objection to taking the prescribed oath, and
  • He considers the prescribed oath to be binding on his conscience, and that he uttered the following words:

“I swear that the contents of this declaration are true, so help me God”

Commissioner of oaths (signature): ……………………………………………………

Full Name: …………………………………………………………….…

Designation (address): ……………………………………………………………….

Office held if appointment is Ex officio (Rank): ……………………………………………..…

Liquor License Price and Step by Step Liquor License Application Procedure Guide