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: 30260512124436623 Application Type: New Registration
Name of Applicant / ANNACHI CAFE Application Date: 12-05-2026
Company: Kind of Business: Food Services - Petty
Designation: Individual Retailer of snacks/tea
Turnover: 50,000 shops
Address of Premises Where Food Business Is Located
Address: 9962/7,9962/8,TH State: Tamil Nadu
IRUMAYAM
Sub-Division/Station/ Pudukkottai Mpty
ROAD,OLD BUS
Division(Railways):
STAND,PUDUKKOT
TAI Pan No: N/A
District/Region/Zone: Pudukkottai
Village: N/A
Pin Code: 622001
Nearest Landmark: N/A
Correspondence Address Details
Address: 9962/7,9962/8,TH State: Tamil Nadu
IRUMAYAM Sub-Division/Station/ Pudukkottai Mpty
ROAD,OLD BUS Division(Railways):
STAND,PUDUKKOT
Pin Code: 622001
TAI
District/Region/Zone: Pudukkottai
Village: N/A
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9943418197 Email-ID: shivaiway@[Link]
Contact Person: NITHYA Aadhaar No: 41XXXXXXXX53
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
Page 1 of 3
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.]
Other than Manufacturer Unit
Sl. No Name of the food category
1 07 - Bakery products
2 15 - Ready-to-eat savouries
3 14 - Beverages, excluding dairy products
4 01 - Dairy products and analogues, excluding products of food category 2.0
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
No Record Found
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 12-05-2026 1169335741445492 pay_SoMP0RUi0Irk9c 100.00
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 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.1.5 Cr. I will apply for License as and when
annual turnover of food businesses exceeds Rs. 1.5 Cr.
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.
Page 2 of 3
Declaration || Condition of License || Inspection Checklist
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
Date & Time : 12-05-2026 12:21:55 IST
Applicant Name : ANNACHI CAFE
Verified through Mobile : 78XXXXXX06
IP Address : [Link]
Page 3 of 3