Application for Registration Food Act 2014 Multi-sites (Form 17/561) Version 1 / January 2017
Page 1 of 2
Application for registration under
Food Act 2014
Multi-site form
Name of the operator of the Risk Based Measure:
Note:
National Programme (NP): If you are applying for multi-site National Programme registration, there can only be
one business and operator. Do not complete the legal owner section in the details
below.
Food Control Plan (FCP): If you are applying for multi-site registration under the template food control plan,
there can be different businesses under the same registration. Please complete this
section for each of the sites listed below. This operator is the person responsible for
the food control plan at that site.
Site 1
FCP only Full legal name of operator of the food business:
Trading name of business:
Address of business/location:
Day to day managers name: Position held:
Mobile phone: Daytime Phone:
Email:
Trading hours:
Site 2
FCP only Full legal name of operator of the food business:
Trading name of business:
Address of business/location:
Day to day managers name: Position held:
Mobile phone: Daytime Phone:
Email:
Trading hours:
29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Fax 03 209 0357
Email info@goredc.govt.nz
www.goredc.govt.nz
Application for Registration Food Act 2014 Multi-sites (Form 17/561) Version 1 / January 2017
Page 2 of 2
Site 3
FCP only Full legal name of operator of the food business:
Trading name of business:
Address of business/location:
Day to day managers name: Position held:
Mobile phone: Daytime Phone:
Email:
Trading hours:
Site 4
FCP only Full legal name of operator of the food business:
Trading name of business:
Address of business/location:
Day to day managers name: Position held:
Mobile phone: Daytime Phone:
Email:
Trading hours:
Site 5
FCP only Full legal name of operator of the food business:
Trading name of business:
Address of business/location:
Day to day managers name: Position held:
Mobile phone: Daytime Phone:
Email:
Trading hours:
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