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: 30250202119030176 Application Type: New Registration
Name of Applicant / Ranjita panigrahi Application Date: N/A
Company: Kind of Business: Trade/Retail - Direct
Designation: Individual Seller
Address of Premises Where Food Business Is Located
Address: Cennal road, State: Orissa
laxmisagar,near
Sub-Division/Station/ Ward 43
shantoshi bihar
Division(Railways):
District/Region/Zone: BHUBANESWAR Pan No: CSYPP0964L
MUNICIPAL
Name: RANJITA PANIGRAHI
CORPORATION
DOB: 09-06-1989
Village: Laxmisagar Village
Gender: FEMALE
Pin Code: 751006
Nearest Landmark: Near maa dalkhai
auto mobile
Correspondence Address Details
Address: Cennal road, State: Orissa
laxmisagar,near Sub-Division/Station/ Ward 43
shantoshi bihar Division(Railways):
District/Region/Zone: BHUBANESWAR Pin Code: 751006
MUNICIPAL
CORPORATION
Village: Laxmisagar Village
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8249601547 Email-ID: N/A
Contact Person: Ranjita panigrahi Aadhaar No: 91XXXXXXXX29
Other Details
In case of New business – intended date of start: 03-02-2025
Source of Water Supply: N/A
Sanction Electricity Load or HP Used: No
Number of years applied for: 5
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Detail(s) of Food Item
[Note:Only standardised food products are allowed to be manufactured as per the list available on FoSCoS.]
Other than Manufacturer Unit
Sl. Name of the food category
No
1 01 - Dairy products and analogues, excluding products of food category 2.0
2 02 - Fats and oils, and fat emulsions
3 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
4 07 - Bakery products
5 12 - Salts, spices, soups, sauces, salads and protein products
6 14 - Beverages, excluding dairy products
7 15 - Ready-to-eat savouries
8 16 - Prepared Foods
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Photo - Aadhar Card View
2 Identity Proof - Aadhar Card View
Other Document(s) Details
[Link]. Documents Description Uploaded Document
1 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.
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Declaration || Condition of License || Inspection Checklist
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
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