Fillable Application for Food Premises Registration/Change of Details (New South Wales)

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Application for Food Premises Registration/Change of Details (New South Wales)

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The Application for Food Premises Registration/Change of Details (New South Wales) form is 3 pages long and contains:

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  • 29 check-boxes
  • 45 other fields

Country of origin: AUSTRALIA
File type: PDF

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FoodPremisesChangeDetails.docx / Building and Environmental Health Unit/ Nov-21 Page 1 of 3
Customer Service | 1300 292 872 | (02) 6670 2400
PO Box 816 Murwillumbah NSW 2484
ABN 90 178 732 496 | tsc@tweed.nsw.gov.au | www.tweed.nsw.gov.au
Application for Food Premises Registration/Change of
Details
A1. Approval Type
Application is hereby made for:
Permanent Food Premise (restaurant, cafes, clubs, supermarkets and others)
Mobile Food Van (van is housed within the Tweed Shire)
Home-based business
Date Effective
NOTE!
New businesses which have not had a ‘fit out approval’ may be required to complete an
“Application for Approval of Food Premises Fit-out Plan” or “Application for Home Based Food
Business (Home Occupation)” form.
A2. Application Type
New Business (not currently registered with Tweed Shire Council).
Existing Business:
Existing Business changing ownership
Existing Business changing details (business name, contact details etc.)
Existing Business proposing minor changes of the premises fit out. Please specify the proposed
minor changes to the fit out:
NOTE!
Major changes to the premises fit-out (including. layout changes, mechanical ventilation etc.)
will require an “Application for Approval of Food Premises Fit-out Plan” to be lodged.
A3. Application Details
Business Trading Name
Surname/s
Given
Name/s
OR
Company/
Organisation
ABN
Applicants
Address
Postal
Address
Contact No. Email
Driver Licence No. State of Issue
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Application for Food Premises Registration/Change of Details
Page 2 of 3 FoodPremisesChangeDetails.docx / Building and Environmental Health Unit / Nov-21
A4. Registered Details (existing business only)
Business Trading Name
Business
Address
ABN
If mobile
Residential
Address of
Operator
Operators
Postal
Address
A5. New Business Details
Business
Trading Name
Business Site
Address
Food Safety Supervisor
Food Certificate Number
Number of full-time equivalent (FTE) food handlers
*
Business Type
Bakery
Supermarket Newsagency
Licensed Club
Cake Shop
Green Grocer Canteen
Service Station
Coffee Shop
Convenience Store School Canteen
Variety Store
Bookshop Cafe
Delicatessen Pharmacy
Food Manufacturer
Restaurant
Poultry Shop Sushi Shop
Takeaway Seafood Shop Pub/Hotel/Tavern
Type of foods handled. List the type of ingredients/food/drinks handled to be sold:
NOTE!
* To calculate the number of FTE food handlers your business has, add up all the hours that
the food handlers are undertaking food handling activities during a working week and divide
by 38 hours (average working week).
Application for Food Premises Registration/Change of Details
Page 3 of 3 FoodPremisesChangeDetails.docx / Building and Environmental Health Unit / Nov-21
A6. Land Description
Lot Number Section DP/NPP/SP
Unit/Street No Street
Suburb/Town
A7. Application Checklist - please provide the following documents attached to your application
Form is completed – applications may be returned if all information is not provided.
Copy of the NSW Food Safety Supervisor Certificate if required.
Copy of the vehicle registration for mobile food business.
Copy of the fit out application form and fit out plans if required.
A8. Privacy and Personal Information Protection Notice
I declare that all the information in this application is true and correct.
Some information requested by Council for this form constitutes personal information under the Privacy and
Personal Information Protection Act 1998 (NSW).
Purpose of Collection: For Council to carry out certification work for the applicant.
Intended Recipients: Council staff, Government agencies
Supply: Legally required, Council may not be able to accept your application if information is not provided.
Right of Access / Correction: Contact Council (02) 6670 2400 or email tsc@tweed.nsw.gov.au
Storage details: Tweed Shire Council, 10-14 Tumbulgum Road, Murwillumbah NSW 2484
Consequence of non-provision of information: Failure to provide correct business details is a breach of the
Food Safety Standards.
Applicants Name Date
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Application for Food Premises RegistrationChange of Details (New South Wales)

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Completed 30 November 2021

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