Application Form for food acceptability
APPLICATION FOR A CERTIFICATE OF ACCEPTABILITY FOR FOOD PREMISES
Regulations Governing General Hygiene Requirements for Food Premises and the
Transport of Food. Government Notice R962 of 23 November 2012
A. PERSON IN CHARGE
|First names and surname of the person in whose | |
|name the certificate of acceptability must be | |
|issued | |
|ID no | |
|Postal address | |
|Contact numbers | |
|Email address | |
B. PARTICULARS OF FOOD PREMISES
|Name of food premises | |
|Type of food premises | |Erf No | |
|(eg building, vehicle, stall, caravan, | | | |
|etc) | | | |
|Location address or address where the | |
|food premises can be inspected | |
If the following are not situated on the food premises, provide the address or describe the location thereof:
| |Erf no |Address |
|Sanitary (latrine) facilities | | |
|Cleaning facilities | | |
|(wash basins for facilities) | | |
|Hand-washing facilities | | |
|Preparation premises | | |
2
C. FOOD CATEGORY
List and describe the food items or the nature or type of food involved:
D. NATURE OF HANDLING
List and describe what your activities will entail (eg preparation or packing for processing)
E. STAFF
Number of persons employed or to be employed : Men _______ Women _______
F. PARTICULARS OF EXEMPTION BEING APPLIED FOR: Regulation 15(1)
G. PARTICULARS OF APPLICANT
|Name and surname | |
|Capacity (eg owner, managing director, secretary, | |
|manager) | |
|Postal address | |
|Contact numbers | |
Date of application: _______/_______/20___ Signature: _____________________
-----------------------
MHS.36.1
MHS.36e
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