Food Safety Compliance System (FoSCoS)
[Link]
Form A
[See Regulation 2.1.1, Regulation 2.1.7]
Application for Registration under food safety and Standards Act,2006
Application No: 30251129122369318 Application Type: New Registration
Name of Applicant / HASINARA BEGUM Application Date: N/A
Company: Kind of Business: Food Services -
Designation: Other(s) WOORKER Anganwadi [ICDS]
Centres
Address of Premises Where Food Business Is Located
Address: KEHERUKHANDA State: Assam
PATHAR
Sub-Division/Station/ Sonitpur Sadar
District/Region/Zone: Sonitpur Division(Railways):
Village: Keherukhanda Pan No: BZIPB9016P
Pathar Name: HASINARA BEGUM
Pin Code: 784110 DOB: 20-03-1990
Nearest Landmark: N/A Gender: FEMALE
Correspondence Address Details
Address: KEHERUKHANDA State: Assam
PATHAR Sub-Division/Station/ Sonitpur Sadar
District/Region/Zone: Sonitpur Division(Railways):
Village: Keherukhanda Pin Code: 784110
Pathar
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8822134853 Email-ID: begumhasinara087@gm
Contact Person: HASINARA BEGUM [Link]
Aadhaar No: 68XXXXXXXX89
Other Details
In case of New business – intended date of start: N/A
Source of Water Supply: Private
Sanction Electricity Load or HP Used: No
Number of years applied for: 5
Detail(s) of Food Item
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[Note:Only standardised food products are allowed to be manufactured as per the list available on FoSCoS.]
Other than Manufacturer Unit
Sl. No Name of the food category
1 16 - Prepared Foods
2 18- Indian Sweets and Indian Snacks & Savouries products
3 07 - Bakery products
4 10 - Eggs and egg products
5 11 - Sweeteners, including honey
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Identity Proof - Aadhar Card View
2 Photo - Aadhar Card View
Other Document(s) Details
[Link]. Documents Description Uploaded Document
No Record Found
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 assure that articles of food mentioned in form satisfy the requirements of FSS Act 2006, Rules and
Regulations made thereunder.
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.
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.
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."
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
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