application form for catering service license
applicant (official seal)
application date
fill in and explain
1. This application form is filled in by the applicant and then submitted to the window of the Health Bureau of the administrative examination and approval center.
2. When filling in, the words should be concise and clear, and there should be no alteration. Fill in the blanks with the word "None".
3. Fill in the scope and types of processing business for the "application for license project".
4. The application form and materials shall be in duplicate, printed (or copied) on A4 paper, and the foreign materials shall be translated into Chinese.
5. Except the original application form and inspection report, all other materials shall be stamped with the seal of the applicant page by page.
the contents and attached materials declared in this application form shall be true and legal, and conform to relevant national norms, standards and regulations. If there is any falsehood, the applicant shall bear the corresponding legal responsibility and bear all the consequences arising therefrom.
apply for a single economic agent
single responsible person, legal person and legal representative
single address, telephone number
number of employees
use area of fixed assets (11,111 yuan)
application for permission:
required application materials:
□1, application for catering service license
.
□3. Schematic diagram of food business premises and equipment layout, technological process and sanitary facilities;
□4. Health check-up certificate of food practitioners
□5. Catering service operators who apply, Identification certificate (photocopy) of its legal representative or owner
□6, food safety management personnel who have been trained in food safety and meet relevant conditions
□7, rules and regulations for ensuring food safety
□8, Record of On-site Verification of Catering Service Permit
□9, On-site Verification Form of Catering Service Permit
□11, and health administrative department. The original shall be returned after passing the examination, Copy submitted for filing
Note: Please tick "√" in □ before the information provided.
Date of acceptance of application: year month day
Signature of the receiver:
On-site supervisor
Opinion
Signature of the handling supervisor:
year month day
Director of Licensing Section
Opinion
Director of Section. > year month day
leader
opinion
leader's signature:
year month day
health
health
line
administration
door
meaning
see department's opinion:
signature of department head: Date of issuance: year month day
No.: flat meal certificate
Validity period: year month day to year month day.