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District Court Rules

Schedule: C - Forms in civil proceedings

Form: 83.2 Certificate to accompany application for (renewal of) certificate of registration - Registration of Clubs Acts, 1904 to 1988


No. 83.2

O.83, r.4 (3) (c)

Registration of Clubs Acts, 1904 to 1988

Certificate to accompany application for † (renewal of) certificate of registration


District Court Area of

District No.

We, Peace Commissioners for ........ *(and I, ........ owner of the premises occupied by the Club hereinafter mentioned) hereby certify that, to the best of our knowledge and belief, the ...... Club designated in the accompanying application has been and is to be conducted as a bona fide Club, and not mainly for the supply of excisable liquor.

Signed ........

Peace Commissioner

Address .........

Date .........

Signed ...........

Peace Commissioner

Address ..............

Date ............

*Signed ............

Owner of Club Premises

Address ..........

Date .........

† Delete if not required
* Delete where premises is owned by Club