Application for renewal food business licence

Applicant's agreement and signature*

If applicant is Corporation/Association

Proprietor, Director, Manager
Date signed

Applicant/s details

Contact details

(no spaces)

(no spaces)

(no spaces)

Street address

Food safety supervisor

*If you are supplying commercially sensitive or confidential information, please ensure you mark such information clearly.

If the application is made by a corporation or an incorporated association, the person signing this form must occupy a position that is legally entitled to make an application on behalf of the organisation.

I understand that the information provided in and with this application may be disclosed publicly under the Right to Information Act 2009 and the Evidence Act 1977.

I am aware that it is an offence to knowingly provide false or misleading information.