Food Safety Compliance System (FoSCoS)
[Link]
Form B
[See Regulation 2.1.2, Regulation 2.1.3, Regulation 2.1.7]
Application for Licenses / Renewal of license under food safety and Standards
Act,2006
Application Reference No: 20260130108253935 Application Type: New License
Name of Company/ SUNIL S Application Date: 30-01-2026
Organizations: Kind of Business: Trade/Retail - Retailer
Address: 21ST 1ST MAIN GST No: Not Provided
ROAD 4TH CROSS
CIN No: Not provided
GANDHINAGAR,
Kolar, Kolar, Port Name: N/A
Karnataka-563101
PAN No: IDCPS8215L
Name: SUNIL S
DOB: 05-06-1992
Gender: MALE
Registered Office Detail(s)
Address: 21ST 1ST MAIN State: Karnataka
ROAD 4TH CROSS Pin Code: 563101
GANDHINAGAR
District : Kolar
Address of Premises for which license is applied
Address: 21ST 1ST MAIN State: Karnataka
ROAD 4TH CROSS Pin Code: 563101
GANDHINAGAR
District : Kolar
Sub-Division : Kolar
Correspondence Address
Address: 21ST 1ST MAIN State: Karnataka
ROAD 4TH CROSS Pin Code: 563101
GANDHINAGAR
District : Kolar
Contact Information
Telephone No: N/A Fax: N/A
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Mobile No: 9901633381 Email-ID: 69sangeeth@[Link]
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Person in charge of operations
Name: SUNIL S Qualification: BCOM
Contact No: N/A Mobile No: 9901633381
Email-ID: 69sangeeth@gmai Address: 21 1st main road 4th
[Link] cross gandhinagar
State: Karnataka District: Kolar
Pin Code: 563101 Photo Id Card: Aadhar Card
Photo ID No: 479973246595 Photo ID Expiry Date: N/A
FoSTaC No: N/A
Trainee Name: N/A
FoSTac Validity End Date: N/A
Person responsible for complying with conditions of License (The person must be same as mentioned
in Form IX, as per FSS Regulations, 2011)
Name: SUNIL S Qualification: BCOM
Contact No: N/A Mobile No: 9901633381
Email-ID: 69sangeeth@gmai Address: 21 1st main road 4th
[Link] cross gandhinagar
State: Karnataka District: Kolar
Pin Code: 563101 Photo Id Card: Aadhar Card
Photo ID No: 479973246595 Photo ID Expiry Date: N/A
Number of years applied for: 2
Kind Of Business: Trade/Retail - Retailer
[Link]. Food Product Category
1 01 - Dairy products and analogues, excluding products of food category 2.0
2 06 - Cereals and cereal products, derived from cereal grains, from roots and tubers, pulses, legumes
and pith or soft core of palm tree, excluding bakery wares of food category 7.0
3 12 - Salts, spices, soups, sauces, salads and protein products
4 13 - Foodstuffs intended for particular nutritional uses
5 14 - Beverages, excluding dairy products
6 15 - Ready-to-eat savouries
Other Detail(s)
Whether Unit is Equipped with an analytical laboratory ? :No
Already Holding License: No
Other License: No
Is Holding PA/NOC: No
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Document(s) Details
[Link]. Documents Submission Document
Type Uploaded/FBO
Remarks
1 List of Directors/Partners/Proprietor/ExecutiveMembers of Society/ Mandatory view
Trust with full address and contact details with nomination of
authorized signatory * View Sample Document
2 Photo I.D and address proof issued by Government authority of Mandatory view
Proprietor/Partner/Director(s)/Authorised Signatory. View Sample
Document
3 Proof of possession of premises. (Sale deed/ Rent agreement/ Mandatory view
Electricity bill, etc.) View Sample Document
4 Partnership Deed/ Self Declaration for Proprietorship/ Mandatory view
Memorandum & Articles of Association towards the constitution of
the firm / Copy of certificate obtained under Coop Act-1861/ Multi
State Coop Act-2002 in case of Cooperative View Sample
Document
5 Form IX: Nomination of Person as per Clause 2.5of FSS Rules, 2008 Mandatory view
(Not applicable in case of Proprietor) Click here to Download
Sample Document in English | Click here to Download Sample
Document in Hindi *
Other Document(s) Details
[Link]. Documents Description Document Uploaded/FBO Remarks
1 NOC from Local Bodies view
Payment Details
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 30-01-2026 3275414683346611 pay_SA9MKexu5H9XNz 1000.00
I/We declare that:
I/We have read,understood and shall abide all provisions of FSS Act,2006 and Rules, Regulations made
therein and orders issued from time to time applicable to declared food business.
I/We have food safety plan to ensure that articles of food mentioned in form satisfy the requirements of FSS
Act 2006 and Rules and Regulations made thereunder.
Our facility shall comply with the general hygiene and sanitary requirements as mentioned in the Schedule 4
of the FSS (Licensing and Registration of Food Businesses) Regulations, 2011.
I/We shall abide with all conditions of License.
Expected capacity of the business is to the best of my knowledge. I/We will modify our License as and when
our eligibility in the mentioned criteria for License changes.
I will be responsible for Permissions/No Objection Certificates from other Govt. bodies wherever required.
I/We have complied with all the permissions/rules, which are applicable to my food business and the
premises of the food business such as CGWA NOC etc.
I/We do not possess more than one active license/ registration for any other food business(es) at the same
premises.
I have read/understood the punishment provision under Section 61 of FOOD SAFETY AND STANDARDS ACT,
2006. "61. Penalty for false information. If a person, in connection with a requirement or direction under this
Act, provides any information or produces any document that the person knows is false or misleading, he
shall be liable to penalty which may extend to ten lakh rupees."
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I do hereby solemnly affirm and declare that all information and particulars furnished here by me are true and
correct to the best of my knowledge.
Declaration || Condition of License || Inspection Checklist
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
Date & Time : 30-01-2026 21:35:51 IST
Applicant Name : SUNIL S
Verified through Mobile : 99XXXXXX81
IP Address : [Link]
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