Phone: Mobile: A PO BOX cannot be a registered office address Email: ABN/ ACN (if applicable) Postal details of Company/Incorporated Association (if different from above) INDIVIDUAL 2 Mr Mrs Miss Ms Last/Family name [ Contact details of Company/Incorporated First/Given name(s) Association Business phone no: Address of Individual 2 making this application: ( ) Business fax no: ( ) Business mobile no: Contact details of Individual 2 making this application: Business email address: Phone: Mobile: ( ) ABN/ACN (if applicable) Email: ABN/ACN (if applicable) APPLICANT SUITABILITY Note: Where this application is in the name of a company, these questions apply to all the executive officers of the Company. Where the application is made COMPANY/INCORPORATED ASSOCIATION DETAILS by individual(s) these questions also apply. B. Is a Company/Incorporated Association applying Attach a separate document detailing responses if to be the operator of the Food Business? Tick ONE further space is required. A trading name or trust is not a legal entity and cannot Have you been convicted of an offence under any hold a food licence. Tick ONE. food legislation? If yes provide details. No Go to Section 2, A No Yes Provide details below and complete Yes attachment 1 Name of Company/Incorporated Association Registered Office Address of Company/Incorporated Have you been issued with one or more penalty Association infringement notices under the Food Act 2006? This is the address where you can receive legal documents. Tick ONE. If yes provide details. This may be the same address as the location of the No activity.
Phone: Mobile: Email: ABN/ ACN (if applicable) INDIVIDUAL 2 Mr Mrs Miss Ms Last/Family name First/Given name(s) Address of Individual 2 making this application: Contact details of Individual 2 making this application: Phone: Mobile: ( ) Email: ABN/ACN (if applicable) COMPANY/INCORPORATED ASSOCIATION DETAILS B. Is a Company/Incorporated Association applying to be the operator of the Food Business? Tick ONE A trading name or trust is not a legal entity and cannot hold a food licence. No Go to Section 2, A Yes Provide details below and complete attachment 1 Name of Company/Incorporated Association Registered Office Address of Company/Incorporated Association This is the address where you can receive legal documents. This may be the same address as the location of the activity. A PO BOX cannot be a registered office address Postal details of Company/Incorporated Association (if different from above) [ Contact details of Company/Incorporated Association Business phone no: ( ) Business fax no: ( ) Business mobile no: Business email address: ABN/ACN (if applicable) APPLICANT SUITABILITY Note: Where this application is in the name of a company, these questions apply to all the executive officers of the Company. Where the application is made by individual(s) these questions also apply. Attach a separate document detailing responses if further space is required. Have you been convicted of an offence under any food legislation? Tick ONE. If yes provide details. No Yes Have you been issued with one or more penalty infringement notices under the Food Act 2006? Tick ONE. If yes provide details. No
DOCS-%236951207-v2-EHS-Application_for_operational_food_licence.docx