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

Regulations

Regulations Governing General Hygiene Requirements for Food Premises, the Transport of Food and Related Matters

Annexures

Annexure A: Application for a Certificate of Acceptability of Food Premises
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ANNEXURE A

[Regulation 3(2)]

 

APPLICATION FORM OF A CERTIFICATE OF ACCEPTABILITY FOR FOOD PREMISES

 

A.        PERSON IN CHARGE

 

Details of the person in whose name the certificate of acceptability must be issued.

 

Surname

 

First names

I.D. / Passport Number

 

 

 

 

 

 

 

Copy of RSA identification document attached.

Copy of Valid Passport attached, if applicable.

Copy of Resident documentation attached, if an Immigrant.

Copy of the Company /Close Corporation Registration

Certificate indicating all Directors /members and addresses

attached, if applicable.

Postal address:

Residential address:

Tel. No.: Business

Tel. No.: Residential

Cell no

E-mail

 

B.        PARTICULARS FOR FOOD PREMISES

Name of Food Premises/Business Trading Name (if any)

Physical Address (Food Premises)

Building Name  (if applicable)

Shop Number (if applicable)

Floor Level (if applicable)

Street Name and Number

Suburb

Erf Number (if applicable)

Postal Address (Food Premises)

Physical Address (In the case of a business solely in the business of transporting perishable food on behalf of someone else)

Postal Address (In the case of a business solely in the business of transporting perishable food on behalf of someone else)

Vehicle(s) to be used for the transporting of Perishable / Prepacked Foodstuffs [Regulation 3 (1)(a) and 14 (6) (a)]

Registration Number

Registration Number

Type of food premises (e.g building vehicle, stall) [Regulation 3 (1)(a)]

Webpage, if applicable

GPS Coordinates, if available

 

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.QUANTITIES OF FOOD TO BE HANDLED

 

Indicate envisaged production output or number of persons to be catered for.

 

E.NATURE OF HANDLING

 

List and describe what your activities will entail (e.g. preparation or packing and processing)

 

F.STAFF

 

Number of person employed or to be employed

Males

Females

Total

 

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

 

H.        PLAN OF PREMISES [Where applicable]

 

Attach to this application, a lay out plan of the premises, drawn on scale 1:50, which indicates the designation of the various areas and position of all equipment.

 

 

I.        PARTICULARS OF APPLICANT

Name


Capacity (e.g. owner, managing director, manager)

I.D./Passport Number

 

Copy of RSA identification Document attached.

Copy of Valid Passport attached, if applicable

Copy of Resident documentation attached, if an Immigrant.

Copy of the Company /Close Corporation Registration

Certificate indicating all Directors /members and addresses

attached, if applicable.

Postal address

Residential address

Tel no: Business

Cell Number

 

J.        DECLARATION

 

I declare that the abovementioned information is correct.

 

I understand that it is my legal responsibility and liability to ensure that this premises complies with all other legislation. and undertake to comply with this undertaking. [Regulation 3(5)(c)).

 

The evaluation and the issuing of the Certificate of Acceptability are done, as the business was presented to the Environmental Health Practitioner.

 

Should conditions change as set out in Regulations 3(5) - (10), I am bound to re-apply for the premises to be re-evaluated for acceptability under these Regulations.

 

 

Date if application:

 

Signature of persons in charge:   _________________________

 

Signature of owner (if not person in charge): ___________________________________