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A food business with only one site Application (Waimakariri District Council New Zealand)

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Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 0800 965 468
Email: records@wmk.govt.nz
Food Act 2014 registration application 190703093649
For a food business NP2 single site
version 4 July 2019
Page 1 of 4
Application for National Programme Level 2 (NP2) registration under
Food Act 2014 with the Waimakariri District Council
A food business with only one site
Before you start, let’s check that you have everything you will need:
·
If you are applying for a National Programme (NP) registration, you can choose your verifier. You will need a
confirming letter from your verifier to attach to this application. A list of recognised verification (or audit) agencies
can be on the MPI website, under ‘registers and lists’. The law requires Councils to verify businesses registered
under the template food control plan.
·
If your business is a registered limited liability company, a copy of the company registration certificate. See
www.companies.govt.nz
·
You need to make sure you can confirm that the operator of the food businesses is resident in New Zealand
within the meaning of section YD 1 or YD 2 (excluding section YD 2(2)) of the Income Tax Act 2007.
·
Details of payment of your application fee:
·
National Programme $165 (incl. GST)
·
If there are any changes to the details provided in this application after it has been sent, tell us in writing
immediately.
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 0800 965 468
Email: records@wmk.govt.nz
Food Act 2014 registration application 190703093649
For a food business NP2 single site
version 4 July 2019
Page 2 of 4
Who is the operator of the food business?
Legal Name(s) of
Operator (e.g.
registered
company,
partnership or
individual):
I have attached a copy of the company name registration from the New Zealand Companies office
(www.companies.govt.nz)
NZ Business
Number
If you have a New Zealand Business Number (NZBN), provide this. For more information about NZBN’s,
including how to get one, see https://www.business.govt.nz/companies
Trading Name, if
any (i.e. ‘Trading
As’):
Same as legal name above
Vehicle
Registration
number:
(if applicable)
(If you are a mobile food business trading outside of the Waimakariri District area you will need to have a third
party verifier
confirmed as part of your application for registration)
Operator Address and Contact Details
You must provide this information to be registered. However, if the address is a dwellinghouse, you may ask that the address is withheld
from the public register by ticking the box below.
Postal Address
Physical / Courier Address (if different to Postal Address)
Address:
Town/City:
Postcode:
Country:
This address is a private dwellinghouse and I wish it to
be withheld from the public register.
This address is a private dwellinghouse and I wish it to
be withheld from the public register.
Contact Person Details
The contact person details entered below will be used for communications about your registration, such as sending approval documents
and renewal reminders. Contact Waimakariri District Council if the details change.
Mobile
Other
telephone
no.
Email
By entering
an email address you consent
to being sent
inf
ormation
and notifications electronically, if required.
Operator day-to-day
manager name and
position
Name:
Position:
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 0800 965 468
Email: records@wmk.govt.nz
Food Act 2014 registration application 190703093649
For a food business NP2 single site
version 4 July 2019
Page 3 of 4
Who will be doing your verification?
Council
Other – insert name of
verification agency
I have attached a confirming letter from my verification agency.
Have you attached the scope of operations document for your business?
Applicant Statement
I confirm that:
1)
I am authorised to make this application as the operator or a person with legal authority to act on behalf of
the operator; and
2)
The information supplied in this application is truthful and accurate to the best of my knowledge and belief;
and
3)
Neither I nor any directors, partners, or managers of the business concerned have been convicted, whether
in New Zealand or overseas, of any offence relating to fraud or dishonesty, or relating to management,
control, or business activities in respect of businesses of a kind (whether in New Zealand or elsewhere)
that are regulated under the Food Act 2014; and
4)
The operator is resident in New Zealand within the meaning of section YD 1 or YD 2 (excluding section YD
2(2)) of the Income Tax Act 2007; and
5)
The operator of the food business is able to comply with the requirements of the Food Act 2014.
Name
Job Title
Signature
Date
Payment required before approval given.
Details of payment of your application fee:
·
National Programme $165 (incl. GST)
Please make cheques payable to Waimakariri District Council
Scope of Operations attached.
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 0800 965 468
Email: records@wmk.govt.nz
Food Act 2014 registration application 190703093649
For a food business NP2 single site
version 4 July 2019
Page 4 of 4
Collection of Information
Collection of Personal Information
Pursuant to Principle 3 of the Privacy Act 1993, we advise that:
·
This information is being collected for the purpose of registering under the Food Act 2014; and
·
The recipient of this information, which is the agency that will collect and hold the information, is the
Waimakariri District Council, Private Bag 1005, Rangiora 7440; and
·
Some of the information collected will be displayed on a public register; and
·
The collection of information is authorised under section 53 or section 83 of the Food Act 2014, which ever
applies. The provision of this information is necessary in order to process an application for registration under
either section 53 or section 83; and
·
The supply of this information is voluntary; and
·
Failure to provide the requested information is likely to result in a return of this application form to the applicant,
and may ultimately result in a refusal to register, in accordance with section 54 and 57 or section 84 and 87, of
the Food Act 2014, which ever applies; and
·
Under Principles 6 and 7 of the Privacy Act 1993, you have the right of access to, and correction of, any
personal information that you have provided.
Collection of Official Information
·
All information provided to the Waimakariri District Council is official information and may be subject to a
request made under the Official Information Act 1982.
·
If a request is made under that Act for information you have provided in this application, the Waimakariri District
Council must consider any such request in accordance with its obligations under the Official Information Act
1982 and any other applicable legislation.
Have you:
filled this form in completely and legibly?
attached completed the scope of operations document?
attached a scale plan of the area to be registered.
attached a letter from your verifier if that isn’t Council?
attached copies of company registration certificates if you have a registered limited
liability company?
read and signed the Applicant Statement?
included fee payment for this application?
Final Check before sending your application to:
(Waimakariri District Council, Private Bag 1005, Rangiora 7400)
SCOPE OF
OPERATIONS
FOR NP2 BUSINESSES
The term ‘Scope of Operaons’ is used to describe the acvies of your food
business and also includes:
• the sector(s) a food business operates under the Food Act 2014,
• what products a food business makes and/or sells,
• how products are sourced and/or supplied,
• how products are processed, if applicable, and
• how products are sold.
What does ‘Scope of Operaons’ mean?
Why do I need to complete a ‘Scope of
Operaons’?
If you are operang a food business you need to tell your local council or Ministry
for Primary Industries (MPI) exactly what your business does.
What do I need to do?
Complete this form and submit it with your applicaon for registraon to your
local council or MPI.
Trading Operaons
How do you source and supply your products / services?
Caterer
Provides food, supplies and services for
a social occasion or funcon or within an
educaon or other facility.
Eat-in premises
Examples: Restaurant, café, residenal care
early childhood educaon (ECE) centres and
kōhanga reo.
Export
Home delivery
Examples: Pizza delivery, meals-on-wheels and
grocery delivery.
Import
Either as a registered food importer or through an
agent who is a registered importer.
Internet
On-line selling of food products.
Market
Example: Stall at farmers’ or other market.
Mobile
Example: Food truck.
On-licence
Eat-in premises that sell alcohol for consumpon
at the same locaon.
Retail
Examples: Supermarket, dairy or other premises
selling direct to the consumer.
Storage provider
Examples: Cold stores and warehouses.
Takeaway
Ready-to-eat meals sold for immediate
consumpon at another locaon.
Transport provider
Ambient or temperature-controlled transport.
Wholesale
Premises selling to other businesses.
Tick all the trading operaons that your business is involved in.
Processes
What processes do you use in your food business?
Acidicaon
Using acid (low pH) to preserve food products.
Examples: Mayonnaise, pickles and shelf stable
condiments.
Concentraon
Increase the thickness of food products by
removing water for example malt extract or yeast.
Drying
Remove moisture from food to make products
such as dried meat, milk powder and vegetable
powder.
Fermentaon
Using micro-organisms to make or preserve food
products. Examples: Kimchee, sourkrout, pickles.
Pasteurisaon (with heat)
Apply heat treatment to preserve food
and drink products. Examples: Beer, juice, sauces.
None of the above
None of the above processes are used.
Operaons
Tick all the acvies your business does, and the products you work with.
Do you:
Sell hot beverages and / or shelf-stable pre-packed food?
Sell manufacturer packaged chilled or frozen food?
Sell ice cream and iced confeconery?
Hot beverage
Examples: Coee, tea and cocoa.
Baked products (without lling or icing)
Examples: Parbaked bread and rolls.
Baked products, with lling or icing
Examples: Custard square, cream bun, sandwiches
and lled roll.
Dairy products
Examples: Cheese, yoghurt, curd, smoothie,
milkshake and cut cheese.
Eggs
Pickled eggs.
Processed fruits & vegetables
Processed and/ or cooked fruit & vegetable
products. Examples: Pesto, juice, frozen
vegetables, fruit salad, rice salad, coleslaw, pasta
salad.
Ice Cream
Food which does not require chilling or freezing.
(In manufacturers’ packaging).
35
30
36
10
20
10
60
70
40
10
50
30
20
80
90
20
Processed meat, poultry & seafood
products
Chilled or frozen, smoked, cooked, marinated,
dried and processed products. Examples: Smoked
chicken, cold smoked sh, salami, sausages, sh
ngers, processed comminuted meat. May be
cooked or raw.
Raw meat, poultry & seafood
Chilled or frozen poultry, meat, insects, sh,
shellsh, live shellsh.
Ready-to-eat meals & snacks
Examples: Ready-to-eat meal, pizza, meat pie,
savoury, lled roll, sandwiches and lled wrap.
Sauces, soups, dressings & toppings
Not shelf-stable. Examples: Dressing, dip, stock,
bouillon and gravy.
Packaged food (shelf-stable products)
In manufacturers’ packaging.
Iced confeconery
Examples: Ice blocks, frozen yoghurt
Extract and pack honey?
32_010
Grow and / or pack food?
Herbs & spices
Fresh herbs & spices, cut or planted.
Minimally processed fruits & vegetables
Minimal processing – is limited to rinsing,
trimming, shelling, waxing and packing. Excludes
sprouts and microgreens.
Mushrooms
Mushrooms and fungi.
Nuts, seeds & grains
Sprouts & microgreens
33
20
30
50
10
40
Transport and distribute or warehouse food?
Provide food to pre-school children?
Bulk food
Bulk food in a container for transport.
Chilled food
Infant formula
Frozen food
Hot food
Shelf-stable food
40
20 10
10
50
30
20
37
22
Do you:
(For immediate consumpon by children under 5 years of age in a centre based service
seng (for example early childhood educaon service centres and kōhanga reo).
Ready-to-eat meals & snacks
Manufacture / make sugar or related products?
Sugar
Raw, brown, white and caster sugar.
Sugar products
Examples: Syrups (glucose), molasses, golden
syrup and treacle.
34
10
20
Manufacture / make confeconery?
Manufacture / make crisps, popcorn, pretzels or similar snack products?
Manufacture / make shelf stable grain-based products?
Manufacture / make water products?
Chocolate & cocoa products
Includes chocolate, carob and compound
chocolate products such as individual chocolates,
blocks and bars, lled or enrobed products.
Example: Scorched almonds.
Crisps & chips
Examples: Potato and reconstuted potato chips,
cassava and vegetable chips, rice crisps, corn chips,
extruded chips and snacks, pretzels, bagel/ pita
chips and crisps.
Sugar confeconery
Examples: Caramels, toees, hard boiled
sweets, gums & jellied sweets, liquorice, fudge,
marshmallow, nougat, icing, frosng, chewing gum
and sherbet.
Snack products
Includes: Dried fruit and nut mixes and pued
wheat. Baked, fried and or curried pulses, popped
corn and rice. Include examples: Bhuja mixes, rice
snacks (nuts/seeds may be a minor component),
curried peas, roasted chickpeas,
Baked products (without lling or icing)
Shelf-stable. Examples: Savoury biscuits, sweet
biscuits, enrobed biscuits, crackers, crispbreads,
corn cakes, rice cakes, wafers, shelf-stable wraps,
cereal/muesli bars that contain fruit, nuts, seeds
etc. as minor components.
Ice
Ice for direct consumpon or to be used in packing
or processing operaons (party ice, bulk ice, salt-
aked ice) or water-based product (frozen or to be
frozen).
10
10
10
10
20
20
20
30
40
20
23
25
28
29
What do you make?
Tick all the acvies your business does, and the products you make (or process)
Do you:
Baked products, with lling or icing
Shelf-stable. Baked products that are lled or iced
aer baking. Example: Filled biscuits.
Breakfast cereals
Examples: Muesli, cornakes and extruded brans.
Pasta
Shelf-stable pasta.
Water-based desserts
Water-based chilled desserts or confecons.
Example: Jelly.
(Including ice, iced confeconery, and iced desserts)
Manufacture / make dried or dehydrated fruit or vegetables?
Dried fruit & nut mixes
Examples: Peanuts and raisins, mixed fruit and nut
combinaon and scroggin mix.
Processed fruits & vegetables
Dried, dehydrated or candied fruits and
vegetables. Dried split lenls or pulses. Examples:
Fruit chips, crystallised fruit, fruit leather,
desiccated coconut and split peas.
26
20
10
Manufacture / make frozen fruit or vegetables?
Bake bread and bread products?
Manufacture / make shelf stable condiments?
Process nuts, seeds and /or coee?
Fermented fruit & vegetable products
Shelf-stable. Examples: Sauerkraut, kimchee and
pickle.
Fermented sauces
Shelf-stable. Examples: Soy sauce and black bean
sauce.
Nut & seed products
Shelf-stable nut & bean-based buers, spreads &
pastes. Examples: Peanut buer and sweet bean
paste.
Processed fruits & vegetables
Shelf-stable. Examples: Jam, fruit puree, relish,
pickle, chutney, preserve, marinade, sauce, salsa,
hummus, pesto tapenade, tahini, guacamole and
mustard.
Sauces, soups, dressings & toppings
Shelf-stable. Examples: Mayonnaise, aioli, tartare
sauce, hollandaise sauce, béarnaise sauce.
20
50
60
10
40
31_010
21_010
27
24
Do you:
Select this secon if you are cung, shelling, dicing, and blanching fruit and / or vegetables and then freezing them.
You should select this secon if you bake bread and bread products only.
Coee bean products
Coee beans whether raw, roasted or ground.
Examples: Roasted and ground coee beans.
Dried fruit & nut mixes
20 30
40
10
Nut & seed products
Examples: Nut or seed our and nut/seed
snack bars (where nuts/seeds are the principle
component).
Nuts & seeds
Mixed nuts or seeds, whether raw, roasted,
ground, avoured or salted excluding raw nuts
or seeds of one type only. Examples: Roasted
almonds and spiced cashews.
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A food business with only one site Application (Waimakariri District Council New Zealand)

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Completed 20 January 2021

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