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: 30241204118348968 Application Type: New Registration
Name of Applicant / Jai Kishan Application Date: N/A
Company: Kind of Business: Trade/Retail -
Designation: Individual Wholesaler
Address of Premises Where Food Business Is Located
Address: B-808, Ground State: Delhi
floor, Block-B,
Sub-Division/Station/ ALIPUR
Sabzi mandi
Division(Railways):
Azadpur
Pan No: ACUPK9675M
District/Region/Zone: North
Name: JAI KISHAN
Village: ALIPUR
DOB: 08-05-1974
Pin Code: 110033
Gender: MALE
Nearest Landmark: Sabzi mandi
Azadpur
Correspondence Address Details
Address: B-1/28, Malka Ganj State: Delhi
District/Region/Zone: Central Sub-Division/Station/ CIVIL LINES
Village: TIMARPUR Division(Railways):
Pin Code: 110007
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9210434999 Email-ID: jkmadnani@[Link]
Contact Person: Jai Kishan Aadhaar No: 89XXXXXXXX08
Other Details
In case of New business – intended date of start: N/A
Source of Water Supply: Public
Sanction Electricity Load or HP Used: No
Number of years applied for: 5
Detail(s) of Food Item
[Note:Only standardised food products are allowed to be manufactured as per the list available on FoSCoS.]
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Other than Manufacturer Unit
Sl. Name of the food category
No
1 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Identity Proof - Aadhar Card View
2 Photo View
Other Document(s) Details
[Link]. Documents Description Uploaded Document
1 Electricity Bill view
2 Photographs of the unit (Entrance/Front facing end of the unit) view
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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