Sale of Food Licence
Application Form
Please return this form to: info@adc.govt.nz or Ashburton District Council, PO Box 94, Ashburton 7740
Applicant Details
Name:
Date of Birth:
Trading Name:
Postal Address:
Phone Number:
Email:
Fax:
Registration Category (please tick where appropriate)
Retail of cakes/sandwiches/baked goods
Grocery
Delicatessen
Retail sale of milk
Eating-house
Operation of food vending machine
Retail of fruits and vegetables
Auction mart where food is handled for sale
Manufacture/preparation/packing/storage of
food for sale (other than retail sale from the
premises)
Signature and Date
I hereby make an application for a Food Licence for the above trade(s):
I have also enclosed the required registration fee of $ ___________
Signed: _____________________________ Date: _________________________________
click to sign
signature
click to edit
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