Food Business Notification

Food Business Notification Form

Food Act 2003

Applicant Details

(Details of person completing form)

Full Name

Phone

Premises Details

Business Trading Name

Premises Address

Phone

Trading Days/Hours

Note: This notification does not constitute development consent or preclude the need for development consent under the EP&A Act 1979 or the Local Government Act 1993.

Food Business Details

Please select

Proprietor Details

Proprietor/Company Name

Operator Full Name

Mailing Address

Phone

ABN/ ACN

Food Safety Supervisor Details

Full Name

Certificate Number

Expiry Date

I declare that to the best of my knowledge, the information provided in this application is accurate and correct. I am aware that I will be required to pay a fee for food premises inspections undertaken by Council, which will be charged in accordance with the most recent Wollondilly Shire Council’s Fees and Charges Schedule .

I agree

Proprietor Signature (Use your mouse or finger to draw)