Fillable Application for MPI Multi Site Template Food Control (Waimakariri District Council New Zealand)

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Application for MPI Multi Site Template Food Control (Waimakariri District Council New Zealand)

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Food Act 2014 registration application 190703093599
For a food business for multi site
Version 3 July 2019
Page 1 of 4
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 311 8900
Email: records@wmk.govt.nz
Application for MPI Multi Site Template Food Control Plan (FCP) or
Template Cheesemakers template registration under Food Act 2014
with the Waimakariri District Council (WDC)
A food business with more than one site all within WDC area
Before you start, let’s check that you have everything you will need:
·
The law requires Councils to verify businesses registered under the template food control plan unless you are a
mobile food business trading outside of the Waimakariri District area, in this situation you will need to have a
third party verifier confirmed as part of your application for registration.
·
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 business is a 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:
• Template Food Control Plan $220 (incl. GST)
·
If there are any changes to the details provided in this application after it has been sent, tell us in writing
immediately.
What type of registration are you applying for?
MPI Food Control Plan template
MPI Cheesemakers template
(Please be aware that all operators who register under the Cheesemakers template must use a third-party custom food control plan approved verifier
to undertake the verification.)
Food Act 2014 registration application 190703093599
For a food business for multi site
Version 3 July 2019
Page 2 of 4
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 311 8900
Email: records@wmk.govt.nz
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 dwelling house, you may ask that the address is withheld
from the public register by ticking the box below.
Postal Address
Address:
Address:
Town/City:
Town/City:
Postcode:
Postcode:
Country:
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 MPI if the details change.
Mobile
Other
telephone
no.
Email
By entering an email address, you consent to being sent information and notifications electronically, if required.
Operator day-to-day
manager name and
position
Name:
Position:
Food Act 2014 registration application 190703093599
For a food business for multi site
Version 3 July 2019
Page 3 of 4
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 311 8900
Email: records@wmk.govt.nz
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:
·
Template Food Control Plan $220 (incl. GST)
Please make cheques payable to Waimakariri District Council
Scope of Operations attached.
Food Act 2014 registration application 190703093599
For a food business for multi site
Version 3 July 2019
Page 4 of 4
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 311 8900
Email: records@wmk.govt.nz
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 scale plans of the areas to be registered.
attached a letter from your verifier (if that won’t be an inspector from your local 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 7440)
Food Act 2014 – Multisite application
Page 5 of 5
Version 2- 13.02.19
Environmental Services Unit
Waimakariri District Council
215 High Street, Rangiora
Private Bag 1005, Rangiora 7440
Ph: (03) 311 8900
Email: records@wmk.govt.nz
Details for other addresses
(Hint: Add additional rows as necessary or attach a file (e.g. spreadsheet) to application email with all of the information required below.
Legal name(s) of site operator (e.g.
registered company, partnership or
individual)
(This is for template food control plan registrations
only. Tick box to confirm company registration
certificate is attached for
any limited liability companies)
NZ Business
Number
(where
applicable)
Site trading name, if any (i.e.
‘Trading As’):
Street/Physical Address (location of actual
place)
(Tick box if you wish the address to be withheld
from the public register because it is a private
dwellinghouse)
Vehicle
Registration
numbers
(mobile
businesses
only)
Site day-to-day
manager position
E.g. ABC Foods Limited
E.g. Yummy CakesRUs, Wellington
Store
E.g. 123 Cakes Road, Faketown 1234
E.g. Store Manager
Vehicle Details (registration)
SCOPE OF
OPERATIONS
SIMPLY SAFE & SUITABLE
TEMPLATE FOOD CONTROL
PLAN 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
Food Service
What processes do you use in your food business?
Serve/sell food directly to customers to be eaten straight away.
If you’ve cked one of the opons above and all of the food that you sell is intended
to be eaten straight away, you don’t need to complete the rest of this form.
Acidicaon
Using acid (low pH) to preserve food products.
Examples: Mayonnaise, pickles and shelf stable
condiments.
Fermentaon
Using micro-organisms to make or preserve food
products. Examples: Kimchee, sauerkraut, pickles.
Handling chilled RTE products
Handling chilled ready-to-eat (RTE) products with
a shelf-life of more than 5 days. Example: Sliced
cooked ham.
Ready-to-eat meals & snacks
Examples: Restaurant meal, catered food,
takeaway, sandwiches, pie, lled roll, smoothies,
milkshake and fresh juice. If you are doing any of
the other foods below, also ck them.
Chinese style roast duck
Holding at serving temperature
Holding at serving temperature in a pie warmer or
bain-marie.
Reheang
Reheang a food that has been previously cooked
for immediate consumpon. Examples: Reheang
a frozen cooked ready-to-eat meal.
Slow or low temperature cooking
Examples: Sous vide, hangi, umu and smoking.
None of the above
None of the above processes are used.
Doner meat
Meals or snacks made using doner meat.
Examples: Kebab and wrap.
Minimally processed fruits and
vegetables
Example: Washed apples.
Sushi
Sushi rolls and sashimi.
Do you produce food to be served or sold directly to customers?
2
10 40
50
20
30
Note:
Operaons
Tick all the acvies your business does, and the products you work with.
Do you:
Sell products that you prepare and / or make?
Baked products (without lling or icing)
Baked products, with lling or icing
Dairy products
Eggs
Infant formula
Examples: Infant formula, follow-on formula and
infant formula products for special dietary use.
Minimally processed fruits & vegetables
Examples: Washed apple and trimmed beetroot.
1
70
80
40
10
110
50
60
30
100
90
20
120
Processed fruits & vegetables
Processed meat, poultry & seafood
products
Raw meat, poultry & seafood
Ready-to-eat meals & snacks
Sauces, soups, dressings & toppings
Shelf-stable products
Under ambient condions. Examples: Packet of
biscuits, can of tomato soup, jar of mayonnaise.
Sell products made by others?
Baked products (without lling or icing)
Baked products, with lling or icing
Dairy products
Example: Scooping ice cream.
Eggs
Infant formula
Examples: Infant formula, follow-on formula and
infant formula products for special dietary use.
Minimally processed fruits & vegetables
Examples: Washed apple and trimmed beetroot.
18
70
80
40
10
110
50
60
30
100
90
20
120
Processed fruits & vegetables
Processed meat, poultry & seafood
products
Raw meat, poultry & seafood
Ready-to-eat meals & snacks
Sauces, soups, dressings & toppings
Shelf-stable products
Under ambient condions. Examples: Packet of
biscuits, can of tomato soup, jar of mayonnaise.
Do you:
Provide food to pre-school children?
Infant formula
20 10
22
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
Sell hot beverages and / or shelf-stable pre-packed food?
Sell ice cream and iced confeconery?
Hot beverage
Examples: Coee, tea and cocoa.
Ice Cream
Food which does not require chilling or freezing.
(In manufacturers’ packaging).
35
36
10
20
10 20
Packaged food (shelf-stable products)
In manufacturers’ packaging.
Iced confeconery
Examples: Ice blocks, frozen yoghurt
Bake bread and bread products?
21_010
You should select this secon if you bake bread and bread products only.
If you have cked any of the Purple acvies above (i.e. not including the Trading
Operaons and Processes secons) you can skip the remaining Green quesons.
Note:
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Application for MPI Multi Site Template Food Control (Waimakariri District Council New Zealand)

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Completed 20 January 2021

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