e-form

Registration of Food Handlers in Terms of LN 178/2001

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Issue date

(Fill in with block letters)

Passport No

ID Card No

Title

Name

Surname

Door Name

Door Number

Building Entry Point Name

Street Name

Locality Name

Post Code

Mobile

E-mail

Category of card applied for :

Tick where applicable:

I, the undersigned, declare that the information supplied above is accurate, complete and not misleading.

Date

Signature

(To be filled by the Food Hygiene Tutor)

I

declare that Mr/Ms

Attended the course and reached the recommended level for Category

Date

Signature

Official Stamp

Attach a photocopy of the original certificate denoting completion of food handler’s course.
Payement of €2.60 (Cheques payable to 'Health Department')

Applications will be accepted from Monday to Friday between: 08:00am to 02:30pm (Winter) and 08:00am to 02:00pm (Summer)

For office use

Issued on

Valid Until

Receipt No

Card No

Data Protection Statement: All data collected is precessed in accordance with the legal provisions and the Data Protection Act 2001.
Personal Data is not disclosed to third parties if not by Law or by other EU Regulations/obligations.
Food Safety Commission Secretariat, Continental Business Centre, Old Railway Track, Santa Venera SVR 9018. Telephone Number: 21337333.
Email Address: foodsafety.commission@gov.mt

Author: J. Vella Version No.: 4 Approved by: DEH Issued by: DEH
Issue Date: 23.06.17 Form No: A F004