Application for Food Premises Licence - East Region

Please fill out the information requested below and click on "Add to Basket".
PLEASE NOTE:
  • Complete the online application form and forward the rest of the information required for your application to the Gaming, Liquor and Security Licensing Branch (refer to the Application Guide for contact information). Your file will not be complete until all of the mandatory attachments (see section 4 of the Application Guide) have been submitted to the Gaming, Liquor and Security Licensing Branch.

  • Initial (new) application fees are now prorated (refer to Section 2 of the Application Guide for more information). Prorated fees do not apply to yearly or seasonal food premises renewals.

* Mandatory fields
* Type of Licence: New   Renewal
If this is a renewal, indicate licence number:
* Choose the Health Protection Branch office closest to your location:
* Name of Food Premises:
* Name of applicant and any authorized representative:
NBGIC Parcel Identification Number (PID):
* Mailing Address:
* Postal Code:
* Telephone: Example: (506)555-1234
Fax (if available): Example: (506)555-1234
Email:
* Correspondence: English   French
* Location of Food Premises:
* Number of Employees:
* Type of Establishment: Class 3
Class 4
Class 5
Class 5 - Abattoir
Class 5 - Dairy Plant
Class 5 - Maple Syrup
Price: $
Seating Capacity:
* Name of Manager:
* Water Supply Communal / Municipal Private (Drilled Well)
    If Private, has a water sample been tested?
    Yes Date yyyy/mm/dd No
     
* Type of Sewage Disposal:
Communal / Municipal Private (Septic System)
     
IMPORTANT - establishments with a private water supply will be required to submit water sample results prior to licensing. Licensed establishments must ensure acceptable (potable) water quality by testing at a frequency established by a Public Health Inspector based on an assessment of the establishment and water supply.
     
* Organization or Individual to receive Annual Renewal Notice:
* Mailing Contact Person:
* Address to where Renewal Notice is to be mailed:
 
* Postal Code:
* Telephone: Example: (506)555-1234
Fax (if available): Example: (506)555-1234
 
TYPING IN YOUR NAME AND ELECTRONICALLY SENDING THIS FORM CONSTITUTES YOUR ELECTRONIC SIGNATURE.
* Signature of Applicant * Date(yyyy/mm/dd)