Lisburn Online Forms - Food Premises Registration Form

Title:

First Name:

Last Name:

E-mail:

Main telephone number:

+

Other telephone number:

+

Street Number and Name:

City or Town:

Postcode:

Country:

Type of Business:

Is your business registered in the UK with Companies House?:

YesNo

Is your business registered outside the UK?:

YesNo

Registration Number:

Limited Company Name:

Registered Office Address:

Your position in the company:

Premises Name:

Street Number and Name:

City or Town:

Postcode:

Country:

Type of Food Business (please tick ALL the boxes that apply):

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 plus

Water supplied to the Food Business Establishment:

Public (Mains) Supply
Private Supply

Full Name of the Manager (if different from operator):

If this is a new business - Date you intend to open:

If this is a Seasonal Business - Period during which you intend to be open each year:

Number of people engaged in the Food Business (please count part-time worker(s), on 25hrs per week or less, as one half):

0 - 10
11 - 50
51 plus

I hereby apply to Lisburn City Council pursuant to:

I confirm that the details that I have given are correct.

Date (dd/mm/yyyy):

Name (BLOCK CAPITALS):

Section 1: Applicant Details
Title:
First Name:
Last Name:
E-mail:
Main telephone number:	+
Other telephone number:	+
Street Number and Name:
City or Town:
Postcode:
Country:
Your Business
Type of Business:
Is your business registered in the UK with Companies House?:	YesNo
Is your business registered outside the UK?:	YesNo
Registration Number:
Limited Company Name:
Registered Office Address:
Your position in the company:
Business address (if different from above)
Premises Name:
Street Number and Name:
City or Town:
Postcode:
Country:
Section 2: Type of Food Business
Type of Food Business (please tick ALL the boxes that apply):	Farm Shop Food Manufacturing/Processing Packer Importer Wholesale/Cash and Carry Distribution/Warehousing Retailer Restaurant/Cafe/Snack Bar Market Seasonal Slaughter StaffRestaurant/Canteen/Kitchen Catering Hospital/Residential Home/School Hotel/Pub/Guest House Private House used for a Food Business Moveable Establishment e.g. Ice Cream Van Market Stall Takeaway Food Broker 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 plus
Water supplied to the Food Business Establishment:	Public (Mains) Supply Private Supply
Full Name of the Manager (if different from operator):
If this is a new business - Date you intend to open:
If this is a Seasonal Business - Period during which you intend to be open each year:
Number of people engaged in the Food Business (please count part-time worker(s), on 25hrs per week or less, as one half):	0 - 10 11 - 50 51 plus
Section 3: Declaration
I hereby apply to Lisburn City Council pursuant to:	I confirm that the details that I have given are correct.
Date (dd/mm/yyyy):
Name (BLOCK CAPITALS):