Millthorpe Markets Temporary Food/Drink Stall Application

COUNCIL APPROVAL TO CONDUCT TEMPORARY FOOD/DRINK STALL
This form is for Council approval to conduct a temporary food/drink stall at the Millthorpe Markets. You are still required to submit a stall application with the Millthorpe Markets committee directly if you haven't already. This form is available here.

Business Details
Stall Name*
Business Name*
Applicant Name*

First NameLast Name
ABN*
What Local Council Area does the stall originate?

Blayney ShireOther
Postal Address*

Postal Address

CityState

Postal Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Public Liability Insurance

All stall holders are required to have public liability insurance for a minimum of $20 million with Blayney Shire Council listed as an interested party. Please ensure documents are valid for the date of the event/s.
Please upload your Public Liability Insurance here*

Cancelof

Food Safety Supervisor
This information is required for all stalls serving the following:

Hot food, Sandwiches, Cakes/slices/scones, Icecream/slushies/donuts
Food Safety Supervisor Name*

First NameLast Name
Certificate Identification*
Expiry Date*

DayMonthYear
Please upload your Food Safety Supervisor Certificate (FSS) here*

Cancelof
NOTE: A copy of the Food Safety Supervisor Certificate is to be available for perusal on demand by an authorised officer AT ALL times the food outlet is operating.

Home Council Approval
Please upload your approval/letter from your Home Council here*

Please provide a copy of approval/registration or last inspection report
Cancelof

Declaration
I have read, understood and will fully comply with the NSW Food Authority 'Guidelines for Food Businesses at Temporary Events.' I declare that the information provided on this form is accurate, complete and correct. I understand that this is an application and approval of this application is not guaranteed.
Signature*

Clear
Name*

First NameLast Name
Date*

DayMonthYear
Should be Empty:

COUNCIL APPROVAL TO CONDUCT TEMPORARY FOOD/DRINK STALL