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: 30250119118833147 Application Type: New Registration
Name of Applicant / DINESHKUMAR Application Date: 19-01-2025
Company: DURAISAMY C/O Kind of Business: Trade/Retail - Food
SALEM SALADS Vending Agencies,
Designation: Individual Food Services - Petty
Retailer of snacks/tea
shops
Address of Premises Where Food Business Is Located
Address: 62 BABY COMPLEX State: Tamil Nadu
2ND FLOOR NEW
Sub-Division/Station/ Salem block
TRICHY MAIN
Division:
ROAD PERIYAR
ARCH NEAR Pan No: BTAPD0526N
Name: DINESHKUMAR
District/Region/Zone: Salem
DURAISAMY
Village: N/A
DOB: 17-01-1993
Pin Code: 636006
Gender: MALE
Nearest Landmark: NELLAI LAALA
SWEETS UPSTAIRS
Correspondence Address Details
Address: 18/75 SOUTH State: Tamil Nadu
MUNIYAPPAN Sub-Division/Station/ Salem block
KOVIL STREET Division:
KARUNGALPATTY
Pin Code: 636006
MAIN ROAD
District/Region/Zone: Salem
Village: N/A
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9677447374 Email-ID: salemfruitsalad@gmai
Contact Person: DINESHKUMAR [Link]
DURAISAMY Aadhaar No: 90XXXXXXXX75
Other Details
In case of New business – intended date of start: 19-01-2025
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Source of Water Supply: Private
Sanction Electricity Load or HP Used: No
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. 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 Photographs of the unit (Entrance/Front facing end of the unit) view
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 19-01-2025 1771797199157667 pay_PlCdjJBamWHd2m 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.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
Date & Time : 19-01-2025 11:57:07 IST
Applicant Name : DINESHKUMAR DURAISAMY C/O SALEM SALADS
Verified through Aadhar : 90XXXXXXXX75
IP Address : [Link]
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