Application for Registration of Premises

FOOD AND DRUGS ACT S.15
To the Chief Environmental Health Officer

I/We *

of *

Daytime Tel Number *

Email Address *

as (proposed) occupier(s) of the premises hereinafter mentioned, HEREBY MAKE APPLICATION in
pursuance of the provisions of Section 15 of the Food and Drugs Act, for the registration by the Chief
Environmental Health Officer of the premises of which are given below, for the purposes specified.

PARTICULARS OF PREMISES

1. Postal address of premises *

2. Purpose for which premises are desired to be registered: *

(a) Catering premises †

(b) Sale of meat or fish

(c) sale or preparation or manufacture for the purposes of sale of bread, confectionery or cakes

(d) Sale or manufacture for the purposes of sale of ice-cream, or the storage of ice-cream intended for sale

(e) Preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale

(f) Sale of any other open food §

Tick as necessary

3. Give details and sizes of all rooms or accommodation in the premises proposed to be used for the above purpose(s) *

4. If used or intended to be used for the purpose of (b) or (d) above, give details of refrigeration plant for maintaining the products at a temperature not exceeding -18 degrees Celcius in the case of frozen and 8 degrees C in the case of chilled products. *

I/WE DO HEREBY CERTIFY that to the best of my/our knowledge and belief, the above particulars are true.

Date *

† “Catering premises” means premises where, in the course of a business, food is prepared and supplied for immediate consumption.

§ ”Open food” means food which is not in a container of such material and so closed as to exclude the risk of contamination but does not include any food mentioned in column 1 of the Sixth Schedule of the Food and Drugs Act, which has been wrapped in the manner described in column 2 thereof.

‡ Different parts of the premises may be registered for different purposes, if this is desired, full details should be given.

Applicant will be required to sign application form prior to document being issued by the Agency.

I certify that the information contained in this Application is true to the best of my knowledge and belief. *

Yes

* obligatory fields

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PARTICULARS OF PREMISES

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