Registration No: F2006/0430

1 December 2020

St Mary & St Peter Pty Ltd

7-Eleven Store #1208C
235-239 Caroline Springs Boulevard
CAROLINE SPRINGS VIC 3023

Dear Sir / Madam

ANNUAL RENEWAL OF REGISTRATION OF FOOD ACT PREMISES

Enclosed is your application to renew your Food Premises registration. Your current registration expires on
31 December 2020.

In response to the Covid 19 Pandemic Council has waived all renewal fees for this year. Please note the
$0 fee in the tax invoice attached.

Renew your registration by completing the enclosed Registration Renewal Application and returning it to
Melton City Council by 18 December 2020.

Council has launched an online portal for you to complete your renewal online. If Council has your email
address on file you will receive your log in details shortly. If you would like a log in please contact
Environmental Health on 9747 7200.

The portal can be accessed here: https://healthonline.melton.vic.gov.au/Account/Login.aspx

When completing the renewal application, please insert any missing details, including the name of your
Food Safety Supervisor, telephone numbers, email address and change anything that is incorrect.

In order for your registration certificate for 2021 to be issued you MUST return the signed form to Council’s
Health and Building Services.

If you have any queries, please contact Environmental Health on 9747 7200.

Kind Regards

Sarah Annells
Coordinator Health and Building
Application for Renewal of Registration
Under the Food Act 1984
Registration number F2006/0430 Tax Invoice: GST Exempt

1. Proprietor’s details
Name St Mary & St Peter Pty Ltd
ABN/ACN

Mailing address 235-239 Caroline Springs Boulevard, CAROLINE SPRINGS VIC 3023

Trading Name 7-Eleven Store #1208C

Business premises address 235-239 Caroline Springs Boulevard, CAROLINE SPRINGS VIC 3023

Phone number 8361 7601

Email address azizguirguis@hotmail.com

Food Safety Supervisor

Class CLASS 2

Registration Type Take Away Foods/Fast Food Outlet/ Kiosk

I / We declare that the Food Safety Program for the subject premises is either identical in all respects with the current
copy lodged with Melton City Council or has not been significantly amended since the last copy was lodged.

Are cigarettes or tobacco products sold to the public from the premises? Yes No

2. Declaration
I/We, the undersigned, hereby apply for renewal of registration of the premises described above, for the year ending 31
December 2021, under the provisions of the Food Act 1984.

Signature of Proprietor or Responsible Officer Date

Privacy Statement: The personal information requested on this form is being collected by Council for the purpose of meeting its legal obligations
under the Food Act 1984, the Public Health and Wellbeing Act 2008, Environmental Protection Act 1970 and associated or related legislation. The
information will be kept confidential and identifying information will not be disclosed to any person for any other purpose. You may access your own
information by contacting Council's Health and Building Services on 9747 7200.

Office Use Only

Receipt type: Ledger number: Fee: $0
401 01805.0860.0863
Receipt Details: 7-Eleven Store #1208C Receipt No:_____________________
235-239 Caroline Springs Boulevard,
CAROLINE SPRINGS VIC 3023

Please return completed form to:

Mail: Email: Phone:
Melton City Council health@melton.vic.gov.au 9747 7200
PO Box 21 (max. file size: 10MB) Fax:
Melton VIC 3337 ABN: 22 862 07889 9743 9970