Application for a
GRAIN (ETHYL) ALCOHOL Permit
LCLB Form 048

You may complete this form at your computer, save it and either mail, fax or e-mail it to the Liquor Control and Licensing Branch.   Please note:  LCLB will not issue a grain alcohol permit for personal use. 

PART 1: Contact Information
1. Applicant Name: 	Last:      	 First:           Middle:      					
2. Business Name: 	     		 
3. Business Address: 	Street:         City:           Postal Code:      									
4. Business Phone:	(      )      	  5. Business Fax : (     )         6.  Business E-Mail:      

PART 2: Business Information
7. Type of business (e.g., manufacturing, scientific, etc.):	     							
8. Reason this business requires grain (ethyl) alcohol: 	     	
9.  Type of permit requested (based on amount of grain (ethyl) alcohol the business requires:   
 Annual Permit for       litres per month (state maximum per month)
 One-time only Permit for 	      litres (state maximum)
10. Expiry date of previous Permit (if any):      
11. Name(s) of designated official(s) who will buy the grain (ethyl) alcohol on behalf of the business: 
	Last:      	   First:           Middle:      
Last:      	   First:           Middle:      
Last:      	   First:           Middle:      
Last:      	   First:           Middle:      

PART 3:  Declaration
I have attached copies of the following documentation to prove that the grain (ethyl) alcohol will be used by this for business purposes: 
 Business licence		 Business registration      Corporate registration       PST or GST registration number
 Other (specify):      

I understand that, under the Liquor Control and Licensing Act, if I fail to disclose a material fact required on this application, or make a false or misleading statement, the Liquor Control and Licensing Branch could suspend or cancel this liquor licence and/or permit.
 
All of the information given in this application is true and complete to the best of my knowledge. 

Name :			Last:      	 First:           Middle:      		

Position:         

Note: The information on this application is collected under the authority of the Liquor Control and Licensing Act (RSBC 1996, c267, s. 15) to determine your eligibility for a liquor licence. The information may also be used by the Liquor Distribution Branch to determine your eligibility to purchase liquor. If you have any questions about the collection, use or disclosure of this information, please contact us.

Signature: 	____________________________________________            Date: 	____________________________
Liquor Control and Licensing Branch      
Mail Address: PO Box 9292 Stn Prov Govt, Victoria BC V8W 9J8  
Phone:  250 387-1254     Fax:   250 387-9184      Web: www.pssg.gov.bc.ca/lclb 
E-mail: lclb.lclb@gov.bc.ca
If you have any questions on acquiring a permit, please contact Margaret Fligg at 250 387-9140