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: 30220915111590587 Application Type: New Registration
Name of Applicant / raviraj dhengle Application Date: 15-09-2022
Company: Kind of Business: Food Services -
Designation: Individual Restaurants, Food
Services - Petty
Retailer of snacks/tea
shops
Address of Premises Where Food Business Is Located
Address: shop no: 124, the State: Maharashtra
address
Sub-Division/Station/ PUNE PCMC ward
commercia
Division(Railways): No-87
District/Region/Zone: Pune Pin Code: 411057
Village: N/A
Nearest Landmark: wakhad
Correspondence Address Details
Address: shop no: 124, the State: Maharashtra
address Sub-Division/Station/ PUNE PCMC ward
commercia Division(Railways): No-26
District/Region/Zone: Pune Pin Code: 411057
Village: N/A
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8087295241 Email-ID: ravirajdhengle@gmail
Contact Person: Raviraj Dhengle .com
Other Details
In case of New business – intended date of start: 15-09-2022
Source of Water Supply: Private
Sanction Electricity Load or HP Used: No
Number of years applied for: 3
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 then Manufacturer Unit
Sl. Name of the food category
No
1 16 - Prepared Foods
2 14 - Beverages, excluding dairy products
3 12 - Salts, spices, soups, sauces, salads and protein products
4 10 - Eggs and egg products
5 08 - Meat and meat products, including poultry and game
6 01 - Dairy products and analogues, excluding products of food category 2.0
7 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
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 Proof of Premises view
2 Proof of Premises view
3 Proof of Premises view
Payment Details
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 15-09-2022 1344594337069119 pay_KI6oEdmNJe7yv3 300.00
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.12 Lacs. I will apply for License as and when
annual turnover of food businesses exceeds Rs. 12 Lacs.
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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