This form should be completed by or for each wholesaler or distributor who is not exempted from the requirement to hold a licence and who wishes to act as a wholesaler or distributor or wishes to renew their existing license. Incomplete forms may be returned to the applicant. Please type or print in black pen. Any alterations must be initialled and dated. Application forms with white out will be returned. All required copies of certificates should be certified.

If any of the details contained in this Application Form should change after this document has been signed, the Applicant will be obliged to submit an updated application form within 30 days, otherwise the Licence will automatically become null and void.

Please download your application form below.


Please email your application to