Vaping Regulatory Authority - Transitional Specialist Vape Retailer election form

Complete this form and declaration if you wish to elect to be a Transitional Specialist Vape Retailer.

Important: You should only complete this form if you meet the following requirements:

Your shop must be open to the public now (open by appointment is not enough, it must be open to the public during advertised opening hours).
Your shop must be R18, and you must take all practicable steps to prevent under-18s from entering.
Your shop must have its own point of sale.
Your shop must be separated such that any aerosol/vapour inside the shop cannot pass directly into another workplace.

If you do not meet ALL these requirements please don't submit this form.

Name (required)

Business name (if applicable)

Registered address (required)

Email address (required)

Phone number (required)

Retail premise addresses nominated to be approved vaping premises (use one address per line if there are multiple premises)

Website addresses nominated to be approved internet sites (use one address per line if there are multiple websites)

Are your sales from vaping products from each of your nominated retail premises more than 50% of your total sales (cigarettes and heated tobacco products are not vaping products) from those premises? (required)

Yes

No – your shop does not meet the sales threshold to be an approved vaping premise, so you are not eligible to be a Specialist Vape Retailer

Are you a New Zealand resident? (required)

Yes

Final declaration (required)

I declare that, to the best of my knowledge, the information I have provided is complete and correct.

Leave this field blank

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