Notification of conduct of food business

Information for the proprietor

Under section 100 of the Food Act 2003 the proprietors of food businesses must notify the

appropriate enforcement agency before operating and under the Food Standards Code (clause 4 – notification) and prior to any change in business details occurring.

Businesses that need to notify Queanbeyan-Palerang Regional Council operate at the retail level and include restaurants, cafes and takeaways; mobile food outlets; supermarkets; convenience stores; childcare centres; canteens and most home-based food businesses.

These details must also be kept up to date with this form completed again if any details change.

For more information on notification requirements visit www.foodauthority.nsw.gov.au

Information collected from this form will be recorded in Council’s list of food businesses. Under section 101A of the Food Act 2003 this list must be made available for inspection by members of the public.

Section A - Food business details

Food business trading name *

Food business address (or food stall/food vehicle operating location) *

Is this form being completed for a *

New businessChange in current business ownershipUpdate of details

If for a new business

From what date does the new owner/proprietor take over the business? *

What date is it proposed that the business will operate from? *

If other - please specify *

Please provide in general the types of foods you will be providing (eg cakes and biscuits, steak sandwiches, noodles and stir-frys, etc) *

Section B - Food business proprietor details

How does your business operate?

As a companyAs a sole trader, partnership or other entity

Company name *

Company ABN *

Registered company address *

Individual name(s) *

ABN *

Residential address *

Proprietor contact details

Preferred postal address *

Email Address *

Phone/Mobile *

Emergency and food recall contact details

Emergency contact name

Emergency contact residential address

Emergency contact email address

Emergency contact phone/mobile

Are you operating a mobile food van? *

YesNo

Mobile food van details

Garaging address *

Vehicle registration number *

State of vehicle registration *

State *

Applicant signature

Signature *

Draw signature|Type signatureClear

Date *

Type name