Food Business Notification Form

Required fields are marked with an asterisk (*).

PART 1 - FOOD BUSINESS OWNERSHIP DETAILS

Name of the Proprietor *

ABN Number *

Mailing Address *

Street/Postal Address *

Business Phone *

Mobile Phone *

Email *

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 *

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

PART 4 - AUTHORISATION

Confirmation * All of the information provided above is accurate to the best of my knowledge.

Notification submitted by *

Date *