Business Registration Form

BUSINESS REGISTRATION FORM

This form is to be used by registered businesses including, food businesses and beauty therapists undertaking skinpenetrating activities including waxing, and public swimming pool/spa pool operators and boarding house operators. This form must be completed prior to the commencement of business and to update registration details as required

Important Information: Council may inspect the without prior notice to assess the business for compliance with legislative requirements. An inspection fee will be charged in accordance with Council's fees and charges .

For further information or questions regarding this form, please contact Council via 9911 6555.

Type of Business

Please indicate the type of business the form relates to *

Please indicate *

Please indicate what type of food is being produced at the food business *eg. takeaway, cafe, bakery

Food Safety Supervisor Name

Food Safety Supervisor Certificate number

Please provide a list of treatments offererd *

Number of pools *

Disinfectant type *

Chlorine Bromine

Type of boarding house *

General boarding houseAssisted boarding house

Total number of bedrooms *

Total number of beds *

Maximum number of residents who can accommodate the premises *

Business Details

Trading Name *

Business address *

Suburb *

Postcode *

Proprietor/Owner name *

Director name *

Company name *Must not be a trustee.

ABN/ACN *

Is the address for Service of documents the same as the business address? *

YesNo

What is your preferred method of receiving invoices? *

PostEmail

Address for Service of documents *

Suburb for Service of documents *

Postcode for Service of documents *

Contact Name *

Contact residential address *

Contact Suburb *

Contact Postcode *

Contact Phone number *

Email *

Hours of Operation *Include days and hours of business operation

Date in which changes will take effect/date of commencement (whichever is applicable) *

DA Consent number if applicable

Applicant Declaration

I declare that to the best of my knowledge, the information provided in this application is accurate and correct.

Applicant Signature *

Draw signature|Type signatureClear

Date *