Fillable Application for registration under Food Act 2014 Selwyn (Selwyn District Council New Zealand)

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Application for registration under Food Act 2014 Selwyn (Selwyn District Council New Zealand)

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Food Act 2014 registration application
For a food business with one site only
Version 1 8.07.2020
Page 1 of 4
Application for registration under Food Act 2014 – Selwyn District Council
A food business with only one site
Before you start, let’s check that you have everything you will need:
•
The completed scope of operations document.
•
If you are applying for a National Programme (NP) registration, you can choose your verifier. You will need a
confirmation letter from your verifier to attach to this application. A list of recognised verification (or audit)
agencies can be found 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 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 for payment of your application fee will be invoiced accordingly.
Notes if you will be completing the form electronically
•
Throughout this form you will need to tick boxes that look like this: . If filling the form in electronically, double
click the box to select that option. A selected box indicates a ‘yes’ answer.
•
If there are any changes to the details provided in this application after it has been sent, notify us in
writing immediately.
What type of registration are you applying for?
MPI Food Control Plan template
MPI Cheesemakers template
NP3
NP2
NP1
(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
For a food business with one site only
Version 1 8.07.2020
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 Selwyn 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
Physical / Courier Address (if different to Postal Address)
Address:
Town/City:
Postcode:
Country:
This address is a private dwelling house and I wish it to
be withheld from the public register.
This address is a private dwelling house 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:
Who will be doing your verification?
Council
Other – insert name of
verification agency (if your
business is FCP, then this
is not applicable)
I have attached a confirming letter from my verification agency.
Note: If you are a mobile trader who also operates outside of the Selwyn District, you are required to be verified by a third-party
verification agency
Food Act 2014 registration application
For a food business with one site only
Version 1 8.07.2020
Page 3 of 4
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
Scope of Operations attached.
Final Check before sending your application to Selwyn District Council
filled this form in completely and legibly?
attached a completed the scope of operations document?
attached a letter from your verifier, if that isn’t Council?
attached a copy of
the company registration certificate, if you have a registered
limited liability company?
read and signed the Applicant Statement?
Have you:
Food Act 2014 registration application
For a food business with one site only
Version 1 8.07.2020
Page 4 of 4
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 Selwyn
District Council; 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 Selwyn 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 Selwyn District
Council must consider any such request in accordance with its obligations under the Official Information Act
1982 and any other applicable legislation.
Collection of Information
Food Act 2014 FCP registration Scope of
Operations
Version 1 8.07.2020
Page 1 of 3
SCOPE OF
OPERATIONS
SIMPLY SAFE & SUITABLE
TEMPLATE
FOOD CONTROL
PLAN BUSINESSES
The term ‘Scope of Operations’ is used to describe the activities 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 Operations’ mean?
Why do I need to complete a ‘Scope of
Operations’?
If you are operating a food business you need to tell your local council exactly what your business does.
What do I need to do?
Complete this form and submit it with your application for registration to your local council.
Food Act 2014 FCP registration Scope of
Operations
Version 1 8.07.2020
Page 2 of 3
TRADING OPERATIONS
How do you source and supply your products / services?
PROCESSES
What processes do you use in your food business?
FOOD SERVICE SECTOR
Serve/sell food directly to customers to be eaten straight away.
Do you produce food to be served or sold directly to customers?
NOTE: If you’ve ticked one of the options above and all of the food that you sell
is intended to be prepared and eaten straight away by the customer, you don’t
need to complete the rest of this form.
For assistance in determining what sections of this application apply to your business,
please call the councils Environmental Health Officers.
□
Caterer
□
Eat-in premises
□
Home Delivery
□
Export
□
Storage provider
□
Internet Sales
□
On- licence premises
□
Transport provider
□
Import
□
Acidification
□
Holding food at
serving temperature
□
Reheating
□
Wholesale
□
Market Sales
□
Mobile trader
□
Retail Sales
□
Takeaway
□
Handling chilled ready-
to-eat products
□
Fermentation
□
Slow or low
temperature cooking
□
None of the above
□
Ready-to-eat meals and snacks
□
Doner Meat
□
Minimally processed fruit and vegetables
□
Sushi
□
Chinese style roast duck
Food Act 2014 FCP registration Scope of
Operations
Version 1 8.07.2020
Page 3 of 3
FOOD RETAIL SECTOR
Serve/sell food that has been prepared/manufactured earlier and is sold in a
retail setting (display cabinet/retail sales)
Do you sell products that you prepare and/ or make?
Do you sell products made by others?
□
Baked products (without filling or icing)
□
Baked products, with filling or icing
□
Dairy products
□
Eggs
□
Infant Formula
□
Minimally processed fruits and
vegetables
□
Processed fruits and vegetables
□
Processed meats, poultry and
seafood products
□
Raw meat, poultry & seafood
□
Ready-to-eat meals and snacks
□
Sauces, soups, dressing and toppings
□
Shelf- stable products
□
Baked products (without filling or icing)
□
Baked products, with filling or icing
□
Dairy products
□
Eggs
□
Infant Formula
□
Minimally processed fruits and
vegetables
□
Processed fruits and vegetables
□
Processed meats, poultry and
seafood products
□
Raw meat, poultry & seafood
□
Ready-to-eat meals and snacks
□
Sauces, soups, dressing and
toppings
□
Shelf- stable products
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Application for registration under Food Act 2014 Selwyn (Selwyn District Council New Zealand)

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Completed 11 February 2021

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