Request To Update Proprietor Contact Details Form

PRIVACY STATEMENT

Your personal information is being collected by Council to update your business record and in accordance with the Food Act 1984 and Public Health and Wellbeing Act 2008. Your details will be stored in Council’s Customer Database and used to identify you when communicating with Council and for Council to deliver services and information to you and will be disclosed as permitted by law. For further information on how your personal information is handled, visit Council’s Privacy Policy.

I have read and understood the Privacy Statement mentioned above (required)

Premises Details

Food Act Registration Number (required)

Business/Trading Name (required)

Premises address (required)

Proprietor Name (required)

ACN

ABN

Do you trade as a (required)

Company/Sole Trader

Other

Please specify

Premises mailing address (if different to premises location

Contact Number(required)

Email Address (required)

Business Trading hours (required)

Preferred Language

Current Proprietor Details

If you are selling your business and changing ownership you need to contact Environmental Health on 9742 0738.

Proprietor work no

Proprietor after hours no

Proprietor mobile no

Email address

Mailing Address

Contact Person Details (if different to the proprietor)

Please provide any updated contact details for your premises.

Contact person’s name

Contact work no

Contact after hours no

Contact mobile no

Email address

Proprietor Name (required)

Proprietor Signature (required)

Sign above

Request To Update Proprietor Contact Details Form

Acknowledgement of Traditional Custodians