Food Business Notification Online Form

PART 1 - Food Business Ownership Details

Name of the Proprietor

ABN Number

Mailing Address

Street/Postal

Business Phone

Mobile Phone

PART 2 - Business Location Information

ACN Number (if applicable)

Registered Business Name

Trading Name of Business

Street Address

Suburb/Town

Postcode

PART 3 - Business Information

Type of Food Business (Please tick)

Number of Employees Handling Food (full time equivalent) e.g. two people working 2.5 days per week equals one full time equivalent.

Description of Food Business

Date Business Commenced *

Day Month Year

PART 4 - Authorisation

Notification submitted by