Application for a Mobile Shop and Traders License

All the necessary food premises approvals and registrations have been obtained and copies have been provided to the Council.

That there is a charge for this service and by submitting this form agree to the relevant fee.

Payment will be made if my / our application is successful.

After the granting of the license, I / We agree to display at all times a copy of the license.

Ensure that at all times while trading that a copy of the license is made available to an authorised officer on request.

Understand that failure to comply with any such request by any person commits an offence against the Mackenzie District Council Mobile Shops and Traders Bylaw 2021.

I / We have read Schedule 2 General Conditions of all Licenses as per the Mackenzie District Council Mobile Shops and Traders Bylaw 2021.

To the best of my knowledge and belief, the information given in this application is true and correct. All actual and reasonable application costs incurred by the Mackenzie District Council will be met by the applicant.

Applicant's Name / Company / Trust (Required)
First Name (Required)
Last Name (Required)
Email (Required)
Postal Address (Required)
Postal Address preferred? Please note: Council’s default method of correspondence is by email and phone	Yes
Telephone No (Required)
Mobile
Date
Customer number (if known)

Company
First Name
Last Name
Email
Postal Address
Postal Address preferred for contact? Please note: Council’s default method of correspondence is by email and phone	Yes
Address is for invoicing purposes?
Telephone No
Mobile

Type of Mobile Shop (Required)
Vehicle Type (Required)
Vehicle Registration (Required)
Designated Mobile Trading Site (Required)	Village Green, Fairlie Denmark Street Greenway, Fairlie Lakeside Drive Carpark, Tekapo Hamilton Drive Carpark, Tekapo Mackenzie Drive Carpark, Twizel
Type of products to be sold (Required)
Signage will be displayed? (Required) Please provide a copy of any planned signage with this application.	Yes No
Days of Operation (Required)
Hours of Operation (Required)
Upload related documents (Required) This includes Location Plan Copies of Food premises approvals and registrations Evidence of Signing Authority - if on behalf of a trust or company File types supported - PDF, PNG, JPG, DOCX, DOC

Current Warrant of Fitness?	Yes No
Current Vehicle Licence Registration	Yes No

Application for a Mobile Shop and Traders License

Details of Applicant

Address for Service (if different from the applicant)

Mobile Shop

Vehicle details (if necessary)

Mobile Food Premises Registration (if Applicable)

Declaration

Privacy Statement

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