Fillable 2020-04-08-food-street-trading-consent-application-v1 Food street trading consent - new, renewal and change applications

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2020-04-08-food-street-trading-consent-application-v1 Food street trading consent - new, renewal and change applications

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ROCHDALE
BOROUGH
COUNCIL
REV 01/04/20
NEIGHBOURHOODS
Mark Widdup
Director of Neighbourhoods
PUBLIC PROTECTION SERVICE
Floor 3, Number One Riverside,
Smith Street, Rochdale, OL16 1XU
Tel: (01706) 924114
Email:licensing.reg@rochdale.gov.uk
Web site: www.rochdale.gov.uk
LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS) ACT 1982
APPLICATION FOR STREET TRADING CONSENT – FOOD
NEW / RENEWAL / CHANGE OF VEHICLE*
Privacy Notice (how we use your information);
Rochdale Borough Council, as the Licensing Authority, collects and records the personal data that you
provide in this form, along with any supporting documentation, in order to process your licence
application to regulate private hire and hackney carriage licensing activities within the Borough.
Appropriate measures are in place to protect your personal data. We may share your information with
other Council Services and organisations that can support our work. The full Privacy Notice provides
information about your rights under current data protection legislation and details what will happen to
your personal data, can be found on the Council’s website at www.rochdale.gov.uk/privacy
IMPORTANT:
• PLEASE READ ALL INFORMATION IN YOUR PACK BEFORE COMPLETION OF THIS FORM
• TWO PASSPORT SIZE PHOTO’S MUST ACCOMPANY THIS APPLICATION
• A SEPARATE APPLICATION MUST BE COMPLETED FOR EACH UNIT
• ALL QUESTIONS ON THIS APPLICATION MUST BE COMPLETED
PERSONAL DETAILS
FULL NAME: _____________________________________________________________________________
ADDRESS:________________________________________________________________________________
POST CODE:____________________________EMAIL ADDRESS:________________________________
DATE OF BIRTH:
N.B A licence cannot be issued to anyone under 17
TELEPHONE (Please supply two numbers you can be contacted on)
FOOD TRADERS ONLY
WITHIN THE LAST 12 MONTHS HAVE YOU SUFFERED FROM ANY OF THE FOLLOWING?
FOOD POISONING YES / NO PARATYPHOID YES / NO
SALMONELLA YES / NO DIARRHOEA/
TYPHOID YES / NO ENTERIC DISORDER YES / NO
STAPHYLOCOCCAL
INFECTION INC. BOILS YES / NO
IF YES PLEASE GIVE DETAIS:_____________________________________________________________
STORAGE ADDRESS OF
UNIT_____________________________________________________________________________________
ADDRESS OF FOOD PREPARATION_________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
REV 01/04/20
DETAILS OF GOODS TO BE SOLD: (please list ALL types of goods to be offered for sale)
LOCATION IN WHICH YOU WISH TO TRADE:
*Maps showing the 3 town centre restricted zones are readily available to you for reference.
There are two other areas which you need to get permission to resort to, these are;
HOLLINGWORTH LAKE & SANDBROOK PARK
You need to provide us with a precise location of where you intend to trade (which must be outside of the
restricted zones)
Days & Times you intend to trade:_____________________________________________________________
Do you wish to have your details given out for any future events? YES / NO
UNIT DETAILS: (UNIT includes vehicle, cart, barrow or portable stalls)
Description (including makers name and height, length and width of unit)
NAME, ADDRESS & TELEPHONE OF OWNER (if different from above)
REGISTRATION/DISTINGUISHING NUMBER_______________________________________________
Chassis number ___________________________________________________________________________
FLEET NUMBER (if applicable):_____________________________________________________________
DECLARATION – ALL APPLICANTS
I declare that the information given in this application is true to the best of my belief and knowledge and I
understand that any information given, subsequently found to be incorrect may result in possible refusal of
revocation of any consent applied for, or given on the basis of that information
This Authority is under a duty to protect the funds it administers, and therefore may use the information you
have provided on this form for the prevention and detection of fraud. It may also share this information with
other bodies responsible for auditing or administering public funds for these purposes.
I have read the Privacy Notice and accept its contents
Signature of applicant________________________________________________________________________
If company or partnership, state position_________________________________________________________
Date______________________________________________________________________________________
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I
-----==-
I I
___________________________________
___________________________________
REV 01/04/20
From 1
st
April 2015 we are introducing a no refund policy if the Consent is
surrendered part way through the year
Ticket No.
Rec No.
Credit/Debit/
Online
Photos Taken
OFFICIAL USE ONLY
FOOD UNIT
SATISFACTORY / UNSATISFACTORY
Date_______________________________
E.H.O______________________________
Highways Comments_________________
Police Comments____________________
Consent Plate No.____________________
SITE ALLOCATED
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Completed 5 July 2020

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