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The Criminal Report form, crucial in the liquor licensing process, ensures that applicants provide essential information about their personal history and consent to a criminal record search. It serves as a gateway for individuals seeking to establish or manage a licensed liquor establishment, liquor manufacturer, or liquor agency. The form requests a range of details. Applicants must disclose their full name, residency status, and prior associations with liquor licenses. Key inquiries revolve around their criminal history, including any drug or alcohol-related offenses and driving infractions within the past five years. Furthermore, important instructions guide applicants on how to complete the form accurately and remind them to attach relevant documents, such as statutory declarations and their driver's license photocopy. The data gathered on this form aids the Liquor Control and Licensing Branch in evaluating eligibility and ensuring that those with a questionable background do not engage in the liquor industry. A signature at the end reinforces the obligation to provide truthful information while also granting the Royal Canadian Mounted Police permission to investigate potential criminal records. For anyone looking to navigate this system, understanding the components of the Criminal Report form is paramount for a successful application.
Criminal Report Example
Personal History Summary and
Consent to Criminal Record Search
Liquor Control and Licensing Form LCLB004
INSTRUCTIONS:
After completing this consent form, please submit it, along with your application and other required documents, to the Liquor Control and Licensing Branch Head Office. You may complete this form at your computer, then print. If you are completing this form by hand, please print clearly using dark ink.
•If you have any questions about completing this form, call the branch
•LCLB forms and supporting materials referred to in this document can be found at: www.pssg.gov.bc.ca/lclb
Location of (proposed) licensed establishment, liquor manufacturer or liquor agency:
StreetCityProvince Postal Code
Legal Entity Name: |
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Licence or Job #: |
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(i.e. sole proprietor, partnership, private corporation, society) |
(not applicable if application is not already in progress) |
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Full Name: |
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Gender (Please check): M |
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(last / first / middle) |
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F 
BIRTHDATE: 
(year / month / day)
Birthplace: 
Last name at birth: 
Other last names used: 
Residence Address: 
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Have you used any other names? (Please check): Yes |
No |
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If yes, please provide name details below: |
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First and middle names at birth: |
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Other first and middle names used: |
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Street |
City |
Province / Country |
Postal Code |
Business Tel with area code: 
Personal Tel with area code: 
Business Fax with area code: 
Business 
1.Do you reside in B.C. for the majority of the year (i.e., more than 6 months)? Yes 
If NO, please provide details of where you reside for the remainder of the year:
No 
2. |
Are you a permanent resident who has resided in Canada for less than the past five years? Yes |
No |
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If yes, attach a copy of your "Record of Landing" (Form IMM1000, Permanent Resident Card or equivalent documentation), as |
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provided by Citizenship and Immigration Canada when you entered the country, and a statutory declaration signed by a lawyer, |
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Notary Public or Commissioner for Taking Affidavits stating that you have not been charged with, discharged, or convicted of a |
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criminal or |
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Canada. (For further information and to review a sample statutory declaration, refer to this LCLB web page: |
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http://www.pssg.gov.bc.ca/lclb/LLinBC/criminal_record_search.htm |
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3. |
Are you either living outside of Canada or a refugee who has been in Canada for less than five years? |
Yes |
No |
If yes, please attach a statutory declaration signed by a lawyer, Notary Public or Commissioner for Taking Affidavits stating that you have not been charged with, discharged or convicted of a criminal or
4. Have you ever held, or do you presently hold, an interest in a liquor licence? |
Yes |
No 
If yes, provide details of licence(s) or application(s): date, location, name of establishment, licence type, current status, etc.):
(Attach a separate sheet to this application if additional space is required.)
5. Do you currently hold a Rural Agency Store appointment from the Liquor Distribution Branch (LDB)? Yes |
No |
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LCLB004 (Last updated 15 May 2012) |
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Personal History Summary and Consent to Criminal Record Search |
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Note: If you are submitting an application for an agent's or manufacturer's licence, please select “N/A” for questions 6 and 7. All other applicants must answer “Yes” or “No” for questions 6 and 7.
6.Have you agreed with anyone to sell the liquor of a manufacturer to the exclusion of another liquor manufacturer?
Yes |
No |
N/A |
If yes, provide details: |
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7.Do you or your immediate family members have any association with, or financial interest in, a liquor manufacturer, a liquor
importer, or the agent of a liquor manufacturer/importer? Yes |
No |
N/A |
If yes, provide details: |
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8.Have you entered into a Shareholder Agreement, Profit Sharing Agreement or other similar agreement with anyone not named in the
licence application? Yes |
No |
If yes, provide details (including percentage of interest shared with others): |
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9.Have you received any
or state? Yes |
No |
If yes, provide one of the following: |
(a)For driving infractions in Canada, provide a copy of your driver's abstract (driving record) for the past five (5) years. For information on how to acquire a copy of your BC driver's abstract, visit
(b)For driving infractions outside of Canada, provide a statutory declaration signed by a lawyer, Notary Public or Commissioner for Taking Affidavits that details the infraction, the date and the sentence or fine. (if not required on Question 3) For further information and to view a sample statutory declaration, refer to this LCLB web page: http://www.pssg.gov.bc.ca/lclb/
LLinBC/criminal_record_search.htm
10.Have you ever been charged with, discharged or convicted of, a criminal or drug/alcohol related offence under the laws of any
country or the laws or bylaws of any provincial, state or local government? Yes |
No |
If yes, provide the following: |
(i)a statutory declaration signed by a lawyer, Notary Public or Commissioner for Taking Affidavits providing details (i.e. date, disposition and sentence or fine, if applicable) of any charges, discharges, convictions or sentences inside or outside of Canada. For further information and to view a sample statutory declaration, refer to this LCLB web page: http://www.pssg.gov.bc.ca/ lclb/LLinBC/criminal_record_search.htm
(ii)a copy of your driver's abstract (driving record) for the past five (5) years. For information on how to acquire a copy of your BC driver's abstract please visit
If you have been issued a driver's licence outside Canada in the past five (5) years, provide a statutory declaration signed by a lawyer, Notary Public, or Commissioner for Taking Affidavits that states you have or have not received any
11.Attach a legible (colour preferred) photocopy of your driver's licence, passport or any other
12.Attach completed "Consent for Disclosure of Criminal Record Information" form (RCMP GRC3584)
DECLARATION AND AUTHORIZATION
My signature below indicates I understand and acknowledge that :
1.All the information given is true and complete to the best of my knowledge. Section 15(2) of the Liquor Control and Licensing Act states "A person applying for the issue, renewal, transfer or amendment of a licence who fails to disclose a material fact required by the form of application or makes a false or misleading statement in the form of application, commits an offence."
2.If the Liquor Control and Licensing Branch grants a licence as a result of this application, it will be granted only to the person(s) named in the application, or to a private corporation containing the principal shareholders and executive officers named in the application or to a public corporation or society containing the executive officers named in the application.
3.My signature authorizes the Royal Canadian Mounted Police to inquire into, and determine whether or not I may have a criminal record and report their findings to the Liquor Control and Licensing Branch. If necessary, I will provide my fingerprints to verify whether or not I may have a criminal record.
4.I understand I must provide a copy of my driving record for the past five (5) years if requested by the general manager.
Signature of Individual: |
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Date signed: |
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Freedom of Information and Protection of Privacy Act - the information for a liquor licence is collected under the authority of the Liquor Control and Licensing Act (RSBC 1996, c.267, s.15). The information is collected for the purpose of determining your eligibility for a liquor licence. 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 the Liquor Control and licensing Branch.
LCLB004 |
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Personal History Summary and Consent to Criminal Record Search |
File Breakdown
| Fact Name | Description |
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| Purpose | The Criminal Report form is designed to collect personal history and consent for a criminal record search applicable to liquor licensing in British Columbia. |
| Governing Law | This form operates under the Liquor Control and Licensing Act (RSBC 1996, c.267, s.15), which outlines the legal requirements for obtaining a liquor license. |
| Submission Instructions | Applicants must submit the completed form along with their application and other required documents to the Liquor Control and Licensing Branch Head Office. |
| Identification Requirement | A photocopy of a government-issued photo ID, such as a driver's license or passport, must be attached to the form. |
| Questions on Criminal Activity | The form includes questions related to any past criminal charges, driving infractions, and other relevant disclosures needed for eligibility verification. |
Guide to Using Criminal Report
Completing the Criminal Report form is an important step in your application process. This form collects personal history and consents to a criminal record search, which is a standard procedure in the liquor licensing application. After filling it out, you will need to submit it along with any other required documents to the Liquor Control and Licensing Branch Head Office.
- Begin with the location of the licensed establishment. Fill in the street address, city, province, and postal code.
- Provide the legal entity name and the licence or job number (if an application is already in progress).
- Enter your full name, gender, and birthdate in the specified format.
- Include your birthplace, last name at birth, and any other last names used.
- Fill in your residence address and indicate if you have used any other names.
- If applicable, provide your business phone, personal phone, business fax, and email.
- Answer whether you reside in B.C. for the majority of the year. If the answer is NO, give details about your other residence.
- Indicate if you are a permanent resident of Canada who has lived here for less than five years. Attach necessary documentation if your answer is YES.
- State if you are living outside Canada or are a refugee in Canada for less than five years. Attach the appropriate statutory declaration if required.
- Answer whether you have held or currently hold any interest in a liquor licence. If YES, describe the details.
- Respond to whether you hold a Rural Agency Store appointment from the Liquor Distribution Branch.
- Provide answers to questions about any agreements related to selling liquor, associations with liquor manufacturers, and shareholder agreements.
- Indicate if you have received any alcohol-related driving infractions in the past five years, and provide the required documents if applicable.
- Answer whether you have ever been charged or convicted of a criminal or drug/alcohol-related offence. Provide a statutory declaration and your driving record if you answer YES.
- Attach a legible photocopy of your driver's licence, passport, or other government-issued ID.
- Attach the completed "Consent for Disclosure of Criminal Record Information" form.
- Sign and date the declaration and authorization section to confirm the accuracy of your information.
Get Answers on Criminal Report
What is the purpose of the Criminal Report form?
The Criminal Report form is designed to gather personal information and consent to a criminal record check for individuals applying for a liquor license. This ensures that applicants meet eligibility criteria set by the Liquor Control and Licensing Branch.
How do I complete the Criminal Report form?
You can complete the form electronically on your computer, then print it out. If you prefer to fill it out by hand, make sure to use dark ink and print clearly. After you complete the form, submit it along with your application and any other required documents to the Liquor Control and Licensing Branch Head Office.
What should I do if I have questions while filling out the form?
If you have questions while completing the form, don't hesitate to call the branch toll-free at 1-866-209-2111 for assistance. They’re there to help you through the process.
What information do I need to provide about my residency?
You’ll need to indicate whether you reside in British Columbia for more than six months of the year. If you answer "No," be prepared to provide details about where you live for the remainder of the year.
What if I have lived in Canada for less than five years?
If you are a permanent resident who has been in Canada for less than five years, you must attach relevant documents such as a copy of your "Record of Landing" or Permanent Resident Card. Additionally, a statutory declaration is necessary, signed by a lawyer or another authorized official, detailing any past criminal offenses.
What documentation is required for driving infractions?
Should you have any alcohol-related driving infractions in the past five years, you need to provide a copy of your driving record or a statutory declaration detailing the infraction, depending on where it occurred. Specific guidelines are available for obtaining the necessary documentation.
Can I apply if I have a criminal record?
Having a criminal record does not automatically disqualify you. However, if you answer "Yes" to such questions on the form, you must provide a statutory declaration with details about the charges or convictions. This includes disclosing when and how they occurred.
How is my information protected after submission?
Your information is collected under the Freedom of Information and Protection of Privacy Act, specifically for determining your eligibility for the liquor license. The data may also be used by the Liquor Distribution Branch to assess your ability to purchase liquor. If you have concerns about privacy, reach out to the Liquor Control and Licensing Branch for clarification.
Common mistakes
When filling out the Criminal Report form, individuals often make several common mistakes that can complicate or delay their application process. One prevalent error is incomplete information. Many applicants fail to provide all required fields, such as their birthplace, last name at birth, or contact details. This omission prevents the authorities from processing the application smoothly. Ensuring that every section is filled out can save time and prevent unnecessary back-and-forth communications.
Another frequent mistake involves inaccuracies in the provided details. Applicants may misspell names or enter incorrect birthdates. These inaccuracies can lead to confusion and misidentification. It's crucial to double-check personal data to maintain consistency across various documents, especially if other names or aliases have been used.
Some individuals neglect to attach the necessary supporting documents, such as statutory declarations or driver's abstracts. Failing to include these attachments can halt the processing of the application until everything is provided. When preparing the form, reviewing the list of required documents and ensuring they are submitted can greatly enhance the application's chances of success.
Additionally, applicants might not read the instructions carefully. Disregarding specific guidelines about where to place checks or how to express consent can lead to the form being rejected. Following instructions thoroughly, even for seemingly minor details, ensures a better chance of the application being processed without issues.
Many people overlook to sign the declaration at the end of the form. This signature is vital, as it affirms the truthfulness of the submitted information. An unsigned form can be considered invalid, leading to delays in the licensure process.
Another common oversight is related to the contact information provided. Sometimes, individuals list outdated phone numbers or email addresses, making it difficult for the Liquor Control and Licensing Branch to reach them if issues arise. It is advisable to provide current contact details and check their accuracy prior to submission.
Some applicants also forget to check the residency requirements. Failing to accurately answer questions about residency, especially concerning their time spent in Canada, can lead to complications. Providing clear explanations about one’s living situation can prevent misunderstandings regarding eligibility.
Finally, the use of inadequate writing tools, like light ink or unclear handwriting, can create an issue. Filling out forms using clear, dark ink, especially when completing by hand, is essential. Forms that are difficult to read can cause delays and miscommunication, hindering the processing of the application.
Documents used along the form
When submitting a Criminal Report form, it's essential to accompany it with several other documents that support the application process. Each of these forms serves a unique purpose and ensures that all relevant facts are examined thoroughly. Below are some important forms and documents that are commonly required.
- Consent for Disclosure of Criminal Record Information (RCMP GRC3584): This form allows the Royal Canadian Mounted Police to obtain information regarding an individual's criminal history. It is crucial for determining eligibility in various licensing situations.
- Driving Record Abstract: This document reflects an individual's driving history over a specific period, often five years. It helps assess any alcohol-related driving infractions, which can be relevant to liquor licensing applications.
- Statutory Declaration: This is a formal statement made under oath. It is often required to confirm the absence of criminal or alcohol-related offenses, especially for applicants who may have a history that necessitates disclosure.
- Liquor Control and Licensing Branch Application Form: This is the main application for obtaining a liquor license. It collects essential information about the applicant, the proposed establishment's location, and any previous licenses held.
- Proof of Identity: Typically a photocopy of a government-issued ID, such as a driver's license or passport, is required. This verifies the identity of the applicant and is essential for confirming their credentials.
- Personal History Summary: This document outlines the individual's background relevant to the application. It summarizes the applicant's identity, residency status, and other pertinent personal information, providing context for the licensing authority.
Assembling these documents correctly enhances the application process and can significantly impact the approval or denial of the liquor license. Ensuring all required forms are completed accurately and submitted in a timely manner is vital for a successful application experience.
Similar forms
The Criminal Report form shares similarities with several other documents commonly used in regulatory or legal contexts. Here are five documents that resemble the Criminal Report form, along with explanations of their similarities:
- Background Check Authorization Form: This document authorizes an entity to conduct a background check on an individual. Just as the Criminal Report form collects personal history and consent for criminal record searches, the background check form involves similar data collection for verifying an individual's history.
- Employment Application Form: Employment applications often request personal history, including criminal records, as part of the hiring process. Both forms seek detailed personal information, including past addresses and any legal issues, to assess eligibility and risk.
- Tenant Application Form: A tenant application form collects similar personal and historical information to evaluate an individual's suitability as a renter. Verification of criminal history in tenant applications mirrors the consent process in the Criminal Report form, focusing on potential risks to property and community safety.
- Permission to Release Information Form: This document allows an organization to obtain records from various sources, much like the Criminal Report form. Both require consent for access to personal data and focus on ensuring that the information collected is directly related to the assessment being made.
- Statutory Declaration Form: A statutory declaration provides a statement of fact that an individual affirms as true. Similar to the Criminal Report form, it often requires disclosure of past criminal history for various applications, ensuring transparency and compliance with legal standards.
Dos and Don'ts
When filling out the Criminal Report form, consider the following guidelines:
- Print clearly if completing by hand, using dark ink.
- Double-check all information for accuracy before submission.
- Include all required supporting documentation, such as identification and statutory declarations if applicable.
- Contact the Liquor Control and Licensing Branch if you have questions.
- Make sure to sign and date the form where indicated.
Avoid the following mistakes:
- Do not skip any questions; ensure all items are addressed.
- Do not use light ink or cursive writing that is difficult to read.
- Do not submit incomplete forms or missing documents.
- Do not provide false or misleading information.
- Do not forget to retain a copy of your completed form for your records.
Misconceptions
Misconception 1: The Criminal Report form is only for individuals with a criminal record.
This form is required for all applicants seeking a liquor license, regardless of their criminal history. It ensures that all necessary background information is gathered to assess eligibility.
Misconception 2: Completing the form is optional if you have never been charged with a crime.
Even if an applicant has no criminal record, they are still required to complete and submit the form to apply for a liquor license. It is a mandatory step in the licensing process.
Misconception 3: You can submit the form without providing a copy of identification.
Applicants must attach a legible photocopy of their driver's license, passport, or other government-issued photo ID to the form. This is crucial for verifying identity.
Misconception 4: The form can be completed with unclear handwriting.
Applicants must print clearly in dark ink if completing the form by hand. Illegible submissions may lead to delays or rejection of the application.
Misconception 5: There is no need to explain previous names.
If an applicant has used different names, they must provide those details on the form. This information helps create a complete background check.
Misconception 6: All questions must be answered, regardless of relevance.
Some questions may not apply to every applicant. In such cases, the individual should select "N/A" for those specific questions. This clarifies which parts of the form are pertinent.
Misconception 7: You cannot contact the branch for help with the form.
Applicants are encouraged to call the branch toll-free at 1-866-209-2111 if they have questions or need assistance while completing the form. Support is available to ensure proper submission.
Misconception 8: Submitting the form guarantees the issuance of a liquor license.
Completion and submission of the form do not guarantee a license will be granted. The Liquor Control and Licensing Branch will conduct a thorough review before making a decision.
Key takeaways
- Complete the Criminal Report form using clear and dark ink if written by hand, or fill it out on a computer before printing.
- Provide accurate personal and contact information, including any previous names and addresses.
- Attach all required documents, such as driver's abstracts or statutory declarations, when applicable.
- Double-check responses to ensure compliance with questions related to criminal history and alcohol-related infractions.
- Submit the completed form along with the application and any other necessary documents to the appropriate office for processing.