New Premises Registration and Change of Existing Registration

New Premises Registration /
Change of Existing Registration

About this form
This form is used for the regulation of food premises, home based businesses, beauty salons, hairdressers, sex
premises and places of shared accomodation. You may use this form to register new premises or to make
changes to registration
for existing premises which fall into these categories.
How to complete this form
1: Ensure that all fields have been filled out correctly.
2: Once completed you can submit this form by mail and in person. Please refer to the Lodgement
details section for further information.
Part 1: Premises Details

Trading Name
Shop Number Building/Arcade
Fixed Trading Address (Mooring location if vessel)
Phone Number Trading Days and Hours
Part 2: Proprietor Details

Given Name/s Family Name
Proprietor/Company Name ABN / ACN of Occupier (if any)
Director Name/s
Postal Address (all correspondence will be sent to this address)
Note: Before this application can be lodged at least one of the modes of contact below must be supplied.
Business Number Mobile Number Home Number
Email Address
Contact Person (if different from above) Position
Date on which changes will take effect / date of commencement of business (whichever is applicable)
TRIM 2011/088791 V01/24 Page 1 of 3

Part 2: Premises Details Continued...
Please indicate for which purpose you are submitting this form by ticking one of the boxes below
New premises Change of proprietor Other
Ceased to trade Change of trading name

If you ticked 'Other' Please provide details in the box below
Please indicate the type of business to which your application relates by ticking the applicable box/es below
Food premises with a Liquor Licence Food premises without a Liquor Licence Home based businesses
Place of shared accomodation Boarding House / Backpackers Beauty salon Hairdresser Sex Premises
Boat/Vessel X Registration number
DA or CDC or OC * Please provide at least

Liquor Licence number one
number *
Licencee
Part 3: Privacy & Personal Information Protection Notice
Purpose of collection: This information is being collected for the purpose of registering or modifying premises,
contacting the business as needed to provide or request information.
Intended recipients: City of Sydney employees. Any approved contractors required to provide this service.
Supply: The supply of this information is required by law. If you are unwilling to provide this information,
the City of Sydney may be unable to provide access to City of Sydney services.
Access/Correction: Please contact Customer Service on 02 9265 9333 or at [email protected] to
access or correct your personal information.
Storage: The City Planning, Development and Transport Unit at the City of Sydney, located at 456 Kent
Street, Sydney NSW 2000, is collecting this information and the City of Sydney will store it
securely.
Other uses: The City of Sydney will use your personal information for the purpose for which it was collected
and may use it as is necessary for the exercise of other functions.
For further details on how the City of Sydney manages personal information, please refer to our Privacy Management
Plan cityofsydney.nsw.gov.au/policies/privacy-management-plan.
Part 4: Lodgement Details
You can lodge the completed application by:

EMAIL: [email protected]
MAIL: City of Sydney DX: 1251
GPO Box 1591
Sydney NSW 2001
IN PERSON: Town Hall House - Level 2, 456 Kent Street, Sydney
See our website for details of all customer service centres and opening hours:
cityofsydney.nsw.gov.au/customer-service-centres
WHAT NOW: Once your application is received a Council Officer will contact you if further information is required.
For further information regarding your application please contact us by visiting cityofsydney.nsw.gov.au/contact-us
Page 2 of 3
Part 5: Applicant Declaration
I declare that to the best of my knowledge, the information provided in this application is accurate and correct.
Proprietor Name Proprietor Signature Date
Office Use Only

File Number Entered by (please print name) Date
Please Note: If this form is received at a One Stop Shop, please forward it to the Health and Building Unit on THH Lvl 16
Page 3 of 3

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New Premises Registration and Change of Existing Registration

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New Premises Registration /

Change of Existing Registration

Part 1: Premises Details

Shop Number Building/Arcade

Fixed Trading Address (Mooring location if vessel)

Phone Number Trading Days and Hours

Part 2: Proprietor Details

Proprietor/Company Name ABN / ACN of Occupier (if any)

Postal Address (all correspondence will be sent to this address)

Contact Person (if different from above) Position

TRIM 2011/088791 V01/24 Page 1 of 3

Ceased to trade Change of trading name

Boat/Vessel X Registration number

DA or CDC or OC * Please provide at least

Part 3: Privacy & Personal Information Protection Notice

Part 4: Lodgement Details

You can lodge the completed application by:

Proprietor Name Proprietor Signature Date

Office Use Only

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