Application for Registration

Application details

What type of registration are you applying for? MPI template food control plan

Food Service, Care Safe and Specialist Retail

National Programme 1

Transporters or distributors of food products. Horticultural food producers and Horicultural packing operations (packhouses). Retailers of manufacturer-packed ice cream and iced confectionery.

National Programme 2

Early childhood centre. Aged care facilities.

National Programme 3

Clubs, handle food but do no make on-site.

If you are not sure, visit the Ministry for Primary Industries website.

How many sites are you registering? Single site Multi site

Proposed opening date

Were you registered with either the Ministry for Primary Industries or your local council before 1 March 2016? Yes No

Verification

Who will be doing your verification? Wellington City Council Other verification agency

Operator details

I am making this application . . .

Name of applicant

This is the individual who will receive any proceeds from the alcohol or ticket sales.

First name

Middle name(s)

Last name

Contact phone

Mobile phone

Email address

Confirm email address

I am primary contact person for this applicant Yes No

Name of contact

First name

Last name

Contact phone

Mobile phone

Email address

Confirm email address

Name of Partner 1

First name

Middle name(s)

Last name

Contact phone

Mobile phone

Email address

Confirm email address

I am primary contact person for this applicant Yes No

Name of Partner 2

First name

Middle name(s)

Last name

Contact phone

Mobile phone

Email address

Confirm email address

Postal address

You must provide this information to be registered. However, if the address is a dwellinghouse, you may ask that the address is withheld from the public register by ticking the box below.

Flat number

Street address

Suburb

City

This address is a private dwellinghouse and I wish it to be withheld from the public register.

Are you a mobile trader? Yes No

Primary trading address

Trading name

Is your primary trading address the same of your postal address? Yes No

Primary trading address

You must provide this information to be registered. However, if the address is a dwellinghouse, you may ask that the address is withheld from the public register by ticking the box below.

Flat number

You must select an address from the list of matches

Street address

Suburb

City

This address is a private dwellinghouse and I wish it to be withheld from the public register.

Are you a mobile trader? Yes No

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

Contact phone

Mobile phone

Email address

Confirm email address

Grease trap

Is there a grease trap at the premises? Yes No

Additional trading addresses

Additional trading address 1

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

+ Add Another Address

Additional trading address 2

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 3

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 4

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 5

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 6

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 7

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 8

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 9

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

+ Add Another Addresss

Additional trading address 10

Type of operator

Legal name(s) of site operator

Upload certificate of incorporation (png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf)

Upload

Site trading name

Street or physical address

Flat number

Street address

Suburb

City

Operator / day-to-day manager

First name

Middle name(s)

Last name

Position

- Remove Address

Confirmation

I confirm that:

1) I am authorised to make this application as the operator or a person with legal authority to act on behalf of the operator.

2) The information supplied in this application is truthful and accurate to the best of my knowledge and belief.

3) I am authorised to make this application on behalf of the operators listed in section 3.

4) Every operator of the food businesses covered by the Food Control Plan is resident in New Zealand within the meaning of section YD 1 or YD 2 (excluding section YD 2(2)) of the Income Tax Act 2007.

5) Every operator of the food businesses covered by the Food Control Plan is able to comply with the requirements of the Food Act 2014.

Signatory

First name

Middle name(s)

Last name

Job title

Fees

The application fee is $.

How would you like to pay? Credit Card
Account 2 Account

By ticking this box, I confirm that all the information I have provided in this application is true and correct.

Refer to Terms and Conditions on the website.

If you need some help or have any questions please give the Service Centre a call on (04) 499 4444

Save Application

Email address

Confirm email address

By clicking 'Save & Send' an email will be sent to the above address containing a link to reload this form at its current state.

Application for Registration Under Food Act 2014

Application details

Verification

Operator details

Name of applicant

Company information

Name of contact

Name of Partner 1

Name of Partner 2

Club information

Name of contact

Trust information

Name of contact

Postal address

Primary trading address

Primary trading address

Operator / day-to-day manager

Grease trap

Additional trading addresses

Additional trading address 1

Street or physical address

Operator / day-to-day manager

Additional trading address 2

Street or physical address

Operator / day-to-day manager

Additional trading address 3

Street or physical address

Operator / day-to-day manager

Additional trading address 4

Street or physical address

Operator / day-to-day manager

Additional trading address 5

Street or physical address

Operator / day-to-day manager

Additional trading address 6

Street or physical address

Operator / day-to-day manager

Additional trading address 7

Street or physical address

Operator / day-to-day manager

Additional trading address 8

Street or physical address

Operator / day-to-day manager

Additional trading address 9

Street or physical address

Operator / day-to-day manager

Additional trading address 10

Street or physical address

Operator / day-to-day manager

Confirmation

Signatory

Fees

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