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Food Safety Compliance System (FoSCoS)

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Form A
[See Regulation 2.1.1, Regulation 2.1.7]
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Application for Registration under food safety and Standards Act,2006

Application No: 30250806121030694 Application Type: New Registration

Name of Applicant / Seema ki Rasoi Application Date: 09-08-2025
Company: Kind of Business: Food Services -
Designation: Individual Restaurants

Address of Premises Where Food Business Is Located

Address: Navodaya nagar State: Uttarakhand

District/Region/Zone: Hardwar Sub-Division/Station/ Hardwar

Village: Aneki Hetmapur Division(Railways):

Pin Code: 249403 Pan No: NEHPK9512P

Nearest Landmark: sai mandir Name: AVISHI KUSHWAHA

DOB: 19-03-2006
Gender: FEMALE

Correspondence Address Details

Address: Navodaya nagar State: Uttarakhand

District/Region/Zone: Hardwar Sub-Division/Station/ Hardwar
Village: Aneki Hetmapur Division(Railways):
Pin Code: 249403

Contact Details

Telephone No: 8954247003 Fax: 8954247003

Mobile No: 8954247003 Email-ID: maax7535@[Link]
Contact Person: Avishi Aadhaar No: 68XXXXXXXX84

Other Details

In case of New business – intended date of start: 01-10-2025

Source of Water Supply: Private
Sanction Electricity Load or HP Used: No
Number of years applied for: 1

Detail(s) of Food Item

[Note:Only standardised food products are allowed to be manufactured as per the list available on FoSCoS.]

English
Page 1 of 3
 Other than Manufacturer Unit
Sl. Name of the food category
No
1 18- Indian Sweets and Indian Snacks & Savouries products
2 01 - Dairy products and analogues, excluding products of food category 2.0
3 07 - Bakery products
4 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
5 12 - Salts, spices, soups, sauces, salads and protein products
6 02 - Fats and oils, and fat emulsions
7 16 - Prepared Foods

Document(s) Details

[Link]. Documents Description Uploaded Document

1 Photo View
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2 Identity Proof - Aadhar Card View
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document/foscos7/2025/08/09/69b8f2b2-
Other Document(s) Details
document/foscos7/2025/08/09/addd4443-
0833-
46db-
4ad4-
[Link]. Documents Description Uploaded 4bf3-
8101-
Document
1 Rent aggreement ae0d-
view
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2 gas bill view
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document/foscos7/2025/08/09/9359a781-
token=eyJhbGciOiJIUzUxMiJ9.eyJzdWIiOiIzMDI1MD
document/foscos7/2025/08/09/a0449761-
token=eyJhbGciOiJIUzUxMiJ9.eyJzdWIiOiIzMDI1MD
99bc-
gn9PQbYRnqK-
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID
0514-
gn9PQbYRnqK-
44fb-
7bTvJf2Zv2VFeQryVu8Hidu0gkzhhZjWz-
Amount
1 Razorpay 09-08-2025 510415779771434 42cd-
7bTvJf2Zv2VFeQryVu8Hidu0gkzhhZjWz-
86fe-100.00
pay_R3IGphE1gIEwiEXTWmkpz_dX9phB9oF9910wQJiVMthKQzCKiA&x-
a802-
XTWmkpz_dX9phB9oF9910wQJiVMthKQzCKiA&x-
[Link]?
auth-
I/We declare that: [Link]?
auth-
token=eyJhbGciOiJIUzUxMiJ9.eyJzdWIiOiIzMDI1MD
user-
token=eyJhbGciOiJIUzUxMiJ9.eyJzdWIiOiIzMDI1MD
I/We have read,understood and shall abide all provisions of FSS Act,2006 and Rules, Regulations made
user-
gn9PQbYRnqK-
id=undefined)
therein and orders issued from time to time applicable to declared food business.
gn9PQbYRnqK-
id=undefined)
7bTvJf2Zv2VFeQryVu8Hidu0gkzhhZjWz-
I/We assure that articles of food mentioned in form satisfy the requirements of FSS Act 2006, Rules and
Regulations made thereunder.
7bTvJf2Zv2VFeQryVu8Hidu0gkzhhZjWz-
XTWmkpz_dX9phB9oF9910wQJiVMthKQzCKiA&x-
I/We 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. XTWmkpz_dX9phB9oF9910wQJiVMthKQzCKiA&x-
auth-
Expected Annual turnover of the food business is under Rs.12 Lacs. I will apply for License as and when
annual turnover of food businesses exceeds Rs. 12 Lacs.
auth-
user-
I have read/understood the punishment provision under Section 61 of FOOD SAFETY AND STANDARDS user-
id=undefined)
ACT,
2006."61. Penalty for false information. If a person, in connection with a requirement or direction under this
id=undefined)
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."

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.

Page 2 of 3
Declaration || Condition of License || Inspection Checklist
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घोषणा || अनुिज्ञप्त की शतेर्ं || ि◌नरीक्षण जांच सूची
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hindi_1.pdf)
hindi_1.pdf)
condition-
condition-
condition-
condition-
checklist-
checklist-
checklist- Date & Time : 09-08-2025 21:27:21 IST
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[Link]) Applicant Name : Seema ki Rasoi
Verified through Mobile : 89XXXXXX03
IP Address : [Link]

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