Notification, Registration or Renewal of a Food Business Form

Required fields are marked with an asterisk (*).

Part 1: Type of Application

Type of Application *

I am notifying my intention to operate a food business (s84)
I am applying to register a food business (s87)
I am applying to renew a food business’ registration (s89)

Part 2: Type of Business

Type of Business *

The food business is a one-off event
The food business is an ongoing business
The food business is mobile food business
The food business will operate from fixed premises

Part 3: Food Business Proprietor's Details

Applicant’s Full Name (Name of the individual or company that will carry on the food business) *

ABN/ACN * If you are a non ABN/ACN holder, Enter your Date of Birth

Business Address *

Postal Address (If different from business address)

Business Phone Number

Mobile Phone Number *

Email Address *

Part 4: Food Business Details

Trading Name *

On-Site Contact (If different from applicant)

Phone Number

Email Address (On-site contact)

Hours of Operation

Mobile Food Business Details

Part 6: Food Business Layout - Mobile Food Business

For mobile food businesses: please attach an A4 plan or photographs clearly depicting the layout of your vehicle, cart, tent, booth or other mobile structure. Refer to the Guidelines for Mobile Food Businesses for more information

Part 7: Food Preparation & Storage - Mobile Food Business

If any food sold from a mobile food business is to be prepared and/or stored at another location not mentioned above, please provide details, including the address of any premises where food is to be stored or prepared.

Part 8: Application Declaration

I declare that the information provided on this form is true and correct. I understand and agree that information on this form, and about the business and its on-going operation, may be shared between Authorised Officers, councils and other jurisdictions to assess this application and the business’ compliance with the Food Act 2003. *

I consent to receiving communications about this application in electronic form

Applicant Name

Notification, Registration or Renewal of a Food Business Form

Services

Circular Head Council