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Food Safety Registration Application Form

The document is an application for registration under the Food Safety and Standards Act, 2006 for Hayagriva Sweets & Savouries, located in Srivilliputhur, Tamil Nadu. The applicant intends to start the food business on October 21, 2024, and plans to sell Indian sweets, snacks, bakery products, and prepared foods. The applicant has declared compliance with the FSS Act and acknowledges the penalties for providing false information.

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4 views2 pages

Food Safety Registration Application Form

The document is an application for registration under the Food Safety and Standards Act, 2006 for Hayagriva Sweets & Savouries, located in Srivilliputhur, Tamil Nadu. The applicant intends to start the food business on October 21, 2024, and plans to sell Indian sweets, snacks, bakery products, and prepared foods. The applicant has declared compliance with the FSS Act and acknowledges the penalties for providing false information.

Uploaded by

zuzaitechnologies
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

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: 30241014117894151 Application Type: New Registration


Name of Applicant / Srivilliputhur Application Date: N/A
Company: Hayagriva Sweets & Kind of Business: Trade/Retail - Retailer
Savouries
Designation: Partner

Address of Premises Where Food Business Is Located

Address: 65/5, East car State: Tamil Nadu


Street
Sub-Division/Station/ Srivilliputhur block
District/Region/Zone: Virudhunagar Division(Railways):
Village: N/A Pin Code: 626125
Nearest Landmark: Andal Temple Ther Pan No: N/A

Correspondence Address Details

Address: 65/5, East car State: Tamil Nadu


Street Sub-Division/Station/ Srivilliputhur block
District/Region/Zone: Virudhunagar Division(Railways):
Village: N/A Pin Code: 626125

Contact Details

Telephone No: N/A Fax: N/A


Mobile No: 9944265224 Email-ID: srithar_sai@[Link].i
Contact Person: Srithar n

Other Details

In case of New business – intended date of start: 21-10-2024


Source of Water Supply: Private
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.]

Page 1 of 2
Other than Manufacturer Unit
Sl. No Name of the food category
1 18- Indian Sweets and Indian Snacks & Savouries products
2 07 - Bakery products
3 16 - Prepared Foods
4 15 - Ready-to-eat savouries

Document(s) Details

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Other Document(s) Details

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No Record Found

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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