Fillable Application for Registration under the Food Act 2014 (Waitomo District Council New Zealand)

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Application for Registration under the Food Act 2014 (Waitomo District Council New Zealand)

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Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
Application for Registration under the
Food Act 2014
Sections 59 and 88, Food Act 2014
MPI Template Food Control Plan: Food Service, Care Safe and Specialist Retail
Before completing this form, please check that you have the required information
• The completed scope of operations document. You can nd this at www.mpi.govt.nz/foodact
• If you are applying for a National Programme (NP) Registration, you may choose your verier. A conrmation letter from
your verier must be attached to this application. A list of recognised verication (or audit) agencies can be found
on the MPI webste, under ‘registers and lists’. The law requires that Council verify businesses registered under an MPI
template food control plan, unless the business chooses to operate the food control plan in more than one district and/
or predominantly wholesale their food.
• If any of the businesses covered in this application are a registered limited liability company, a copy of the company
registration certicate. See www.companies.govt.nz
• Registration information for every address covered in this application.
• A oor plan of the business.
• Conrmation that the operator of the food business 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.
• If you had a food control plan registered with either the Ministry for Primary Industries or Waitomo District Council before
1 March 2016, please ensure you have your previous registration ID on hand. These are ID’s such as FSA-JBIP-12345 or
WEBB-12345.
• Application Fee.
Registration
What type of registration are you applying for?
(You will know which type of registration is appropriate for your application once you have completed the Scope of Operations
document)
National Programme 3
National Programme 2
National Programme 1
If you had a food control plan registered before 1 March 2016, what was your registration ID number(s)?
Applicant Details
This section is for the owner or person in control of the food business.
(If you are applying for a National Programme registration, there can only be one business and operator. If you are applying for
registration under the template food control plan, there can be different businesses under the same registration. In that case, this
operator is the person responsible for the food control plan, the table on page 3*** is for listing your other businesses and information.
Legal Name(s) of applicant (individual, partnership or registered company)
Please attach a copy of the company name registration from the NZ Companies Ofce, www.companies.govt.nz
New Zealand Business Number
If you have a New Zealand Business (NZBN), please provide this. For more information about NZBN’s including how to get one, visit
www.business.govt.nz/companies
Trading Name, if any (i.e. trading as)
Same as legal name above
OR
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Applicant 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 (include post code and country
This address is a private dwelling/house and I wish it to be withheld from the public register.
Physical/courier address (if different to postal)
This address is a private dwelling/house and I wish it to be withheld from the public register.
Contact Details
The contact person details entered below will be used for communications about your registration, such as sending
approval documents and renewal reminders. Please contact Waitomo District Council if the details change.
Full Name
Postal address (include post code and country
Mobile Fax
Contact Numbers
Phone
Email
Physical Address of the Premises
This is the physical address of the building(s) to be covered by the food control plan or national programme. If more than
one premises is to be covered, please list the primary address here and ensure any others are listed on the table on page 3*
Physical address of the premises (number, street/road, town)
By providing an email address you consent to being sent information and notications electronically, if required
Day-to-day Manager Details
Full Name
Position held
Verication Provider
Who is your verifying agency?
Waitomo District Council (note: the Council contracts Waipa District Council staff to undertake the verifications)
Other - please provide name of verifying agency below
I have attached a conrming letter from my verication agency
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Final Check before submitting your application to Waitomo District Council
Application form fully completed and legible
Have you:
Scope of Operations document fully completed
Conrmation letter from you verier (if this is not Waitomo District Council)
Read and signed the Applicant Statement
Included the fee payment
Applicant Statement
I conrm 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.
I also conrm that:
4. I am authorised to make this application on behalf of the operators; and
5. Every operator of the food businesses covered by the Food Control Plan 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
6. Every operator of the food businesses covered by the Food Control Plan is able to comply with the requirements of the
Food Act 2014.
Full Name
Position held
Signature Date
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.
• The recipient of this information, which is the agency that will collect and hold the information is the Ministry of Primary
Industries, PO Box 2526, Wellington 6140 and Waitomo District Council, PO Box 404, Te Kuiti 3941.
• Some of the information collected will be displayed on a public register.
• 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.
• The supply of this information is voluntary, however 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.
• 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 Ofcial Information
• All information provided to Waitomo District Council is ofcial information and may be subject to a request made
under the Local Government Ofcial Information and Meetings Act 1987
• If a request is made under the Act for information you have provided in this application, Waitomo District Council must
consider any such request in accordance with its obligations under that Act and any other applicable legislation.
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Details for other Sites
Legal names(s) of site operator (e.g. indi-
vidual, partnership or registered company)
This is for template food control plan
registration only. Tick the box to conrm
the company registration certicate
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 the box if you wish the address to be
withheld from the public register because
it is a private dwelling/house)
Vehicle registration
numbers (for mobile
businesses only)
Site day-to-day manager
position
e.g. ABC Foods Limited e.g. Yummy Cakes,
Wellington Store
123 Cake Road, Faketown 1234 e.g. Store Manager
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Standard Terms for Verification
Definitions
In this agreement, the words "we", "us" and so on mean Waipa District Council (WDC) or any contractors, and we have
used "you" and so on to mean the customer named in the verification agreement.
In these terms the words "service" and "services" cover the services we have agreed to provide (and anything else we
do at your request) which are described below.
"The Act" means the Food Act 2014 and any amendments to that Act or Regulations made under the Act such as the
Food Regulations 2015.
"The programme" means the risk based measure, National Programme (Level 1, 2 or 3), the customer is required to
operate under.
Period of Agreement
Subject to the other provisions of these terms, our obligations to each other start on the start date and end on the
termination of the agreement, except where those obligations are expressly stated to survive termination. Either party
may terminate this agreement with not less that 14 days notice to the other party.
Preconditions or Conflicts of Interest
If any staff from WDC have been involved in the design of your food premises or procedures, we cannot act as your
verifier. We aim to undertake the agreed services in an independent and impartial manner at all times. WDC has
been approved by the Ministry for Primary Industries (MPI) as a recognised verifier under the Act.
Nature of the Services
We will verify your food safety practices as required during the term of this agreement and (where appropriate) report
your compliance with the programme and with the relevant provisions of the Act to your registration authority and/or
MPI.
We will obtain such evidence as we consider sufficient to enable us to draw reasonable conclusions as to whether or
not you are complying with the programme and with the relevant provisions of the Act. The nature and extent of our
procedures will vary according to our assessment of your systems, premises and practices, and, where we wish to
place reliance on it, your internal control framework.
We will report in writing any matters we consider important and requiring attention.
If we believe there are potential food safety or suitability issues eg product recall, complaints received, on direction
from MPI or your registration authority, we may carry out unscheduled verification of a business. Additional fees may
be incurred in these circumstances.
Purpose of the Services
Our services are designed to monitor compliance with the risk based measure and with the relevant sections of the
Act. If any deficiencies in internal controls and practices, not strictly relevant to the verification, come to our attention,
we will advise you of these, but we only aim to identify deficiencies within the scope of the verification.
Any other services we may provide from time to time at your request are distinct from our function as verifiers and may
be refused if this would generate a conflict of interest with regards to your verification.
Our agreeing to provide the services does not constitute a permit, authorisation, or other permission under any Act,
Regulation, or Bylaw. Our verification does not remove your liability for the consequences of failure to comply with any
Act, Regulation, Bylaw, or other requirement.
Standard of Service
When we provide services to you, we will use our best endeavours to:
• provide the services with care and skill
• ensure your verifier is knowledgeable and competent to verify your specific food business operations. This may
include contracting a Technical Expert to assist us in the verification your food business
• provide the services within a reasonable time or within any agreed time limit
• provide a reliable service although we do not guarantee it will be fault free
• provide a report your registration authority within 10 working days of completing the verification in any situation
where WDC is not the registration authority, or where the registration authority is MPI, information required in the format
specified within 10 days of the end of the calendar month.
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Standard Terms for Verification
Confidentiality
All communications between us (the agency) and you (the customer) are treated with strict confidentiality. All
electronic records maintained by us are only accessible by approved staff. You may request a copy of any
correspondence on your customer file at any time, eg, a past verification report. A Food Safety Officer or MPI
representative may request verification information from us or you. We will notify you if any such person requests such
information from us about your food business. 4
Any corrective actions or non-compliances identified during the verification process of your business will be notified to
the applicable registration authority and/or MPI.
Complaints and disputes
If you have a complaint in relation to our services, or the person conducting them, or you dispute any
recommendation put forward by your verifier, or you would like to comment on the service you received, please
contact the Team Leader Environmental Services. We document all complaints, disputes and compliments in an
attempt to continually improve our service under our Quality Management System. All complaints or disputes are
confidential.
Your General Responsibilities
Within 14 days you must advise us of a change of verifier.
To enable us to properly carry out our statutory responsibilities as a recognised verifier, you must maintain records
which comply with the requirements of the Template Food Control Plan or National Programme (level 1, 2 or 3 as
applicable) and which contain sufficient detail to enable us to ensure that:
• The food preparation tasks identified in your program are being properly carried out by appropriate staff who have
been suitably trained and instructed
• Any restrictions or conditions placed on registration are being complied with
• You notify us of any further information, including any post verification events, which may have a bearing on our
verification responsibilities. This must include changes to the scope of your operation or significant changes
• All information you give us needs to be correct and complete
Our Charges
Verification fees are prescribed within WDC fees and charges, these are subject to annual review and are publicly
notified through the Annual Plan process. We will provide you with an invoice that must be paid by the 20th of the
following month.
Our Right to Suspend or Restrict Any Service
If your registration is revoked, surrendered or substituted, or if you do not pay our charges or meet any other
responsibilities you have to us, we may suspend or restrict the services at any time. Such activities will be reported to
the registration authority and/or MPI.
Our Right to Stop Providing the Service
If your registration is revoked, surrendered or substituted, or if you do not pay our charges or meet any other
responsibilities you have, we may stop providing any of our services to you. This right is additional to any other right or
remedy we may have against you under the Act. Otherwise, where we have agreed to provide a service for a
minimum period, we will continue providing it until the end of that period, and we will notify you with 14 days before
we stop providing the service.
More Than One Customer
Every person named as a customer in this agreement must meet all of your responsibilities under this agreement.
Sending Invoices and Notices
We will send invoices and other notices to the last address you have given us. We can assume any invoice or notice
we send by post has been delivered 5 days after we post it. Please tell us if you change your address.
Verification agreement records
All verification agreements will be kept on our records for a minimum of 4 years in relation to our record keeping
requirements under the Food Act 2014. Verification reports are retained indefinitely.
Changing These Terms
Any changes to the terms of this agreement must be in writing and signed by us.
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Application for Registration under the Food Act 2014 (Waitomo District Council New Zealand)

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Completed 8 November 2020

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