Cookstown District Council

APPLICATION FOR THE REGISTRATION OF A FOOD BUSINESS ESTABLISHMENT

(Regulation (EC) No. 852/2004 on the Hygiene of Foodstuffs, Article 6(2))

This form should be completed by food business operators in respect of new food business establishments and submitted to the relevant Competent Authority 28 days before commencing food operations. On the basis of the activities carried out, certain food business establishments are required to be approved rather than registered. If you are unsure whether any aspect of your food operations would require your establishment to be approved, please contact the [District Council] for guidance.

Name of food business
(trading name)

Address of establishment:
(or address at which moveable establishment is kept)

Full Name of food business operator

Telephone Number:

Email Address:

Type of food business (Please tick ALL boxes that apply):

	Farm Shop		Staff restaurant/canteen/kitchen
	Food manufacturing/processing		Catering
	Packer		Hospital/residential home/school
	Importer		Hotel/pub/guest house
	Wholesale/cash and carry		Private house used for a food business
	Distribution/warehousing		Moveable establishment e.g. ice cream van
	Retailer		Market stall
	Restaurant/café/snack bar		Food Broker
	Market		Takeaway
	Seasonal Slaughterer		Other (Please give details):
			Other (Please give details):

Type of Business:

	Sole Trader
	Partnership (please enter Partner names below)
	Partner Names:
	Limited Company (please complete section below)
	Limited Company Name:
	Company No:
	Registered Office Address:
	Other (Please give details):

Number of vehicles or stalls kept at, or used from, the food business establishment and used for the purposes of preparing, selling or transporting food:

5 or less 6-10 11-50 51+

Water supplied to the Food Business Establishment:

Public (Mains) supply Private supply

Full Name of manager (if different from operator)

Is this a new business?

If yes: Date you intend to open: (DD/MM/YYYY)

Is this a seasonal business?

If yes: Period during which you intend to open each year: