Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No. 54 of 1972

Regulations

Purchase

ANNEXURE A

[Regulation 3(2)]

APPLICATION FORM OF A CERTIFICATE OF ACCEPTABILITY FOR FOOD PREMISES

A. PERSON IN CHARGE

Surname and first names of person in whose name the certificate of acceptability must be issued:

.................................................................

I.D. Number .........................................

B. PARTICULARS FOR FOOD PREMISES

Name of food premises (if any)
Erf No. (if applicable)
Type of food premises (e.g. building, vehicle, stall)
Location address or address where the food premises can be inspected

If the following are not situated on the food premises, note the address or describe the location thereof:

	Erf No.	Address
Sanitary (latrine) facilities
Cleaning facilities (wash-basins for facilities)
Hand-washing facilities
Storage facilities for food/facilities
Preparation premises

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 (e.g. preparation or packing and processing)

STAFF

Number of person employed or to be employed

F. PARTICULARS OF EXEMPTION BEING APPLIED FOR [Regulation 14(1)]

G. PARTICULARS OF APPLICANT

Name
Capacity (e.g. owner, managing director, secretary, manager)
Postal address
Tel no:

Date if application:

Signature