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: 30250524120171804 Application Type: New Registration
Name of Applicant / HARSH NARESH Application Date: 24-05-2025
Company: AGRWAL Kind of Business: Trade/Retail - Direct
Designation: Individual Seller
Address of Premises Where Food Business Is Located
Address: At main road bazar State: Maharashtra
choukh sakhritola
Sub-Division/Station/ Salekasa
District/Region/Zone: Gondiya Division:
Village: Sakaritola Pan No: DZOPA5458J
Pin Code: 441902 Name: HARSH NARESH
Nearest Landmark: N/A AGRWAL
DOB: 17-12-2000
Gender: MALE
Correspondence Address Details
Address: At main road bazar State: Maharashtra
choukh sakhritola Sub-Division/Station/ Salekasa
District/Region/Zone: Gondiya Division:
Village: Sakaritola Pin Code: 441902
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8010635752 Email-ID: harshnareshagrawals
Contact Person: HARSH NARESH ak@[Link]
AGRWAL Aadhaar No: 62XXXXXXXX15
Other Details
In case of New business – intended date of start: 24-05-2025
Source of Water Supply: N/A
Sanction Electricity Load or HP Used: No
Number of years applied for: 1
Detail(s) of Food Item
Page 1 of 3
[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 13 - Foodstuffs intended for particular nutritional uses
Note : Products under Sub categories, namely, 13.1, 13.2 and 13.3 are not allowed for Direct Selling,since
advertisement or marketing or promotion of these products are restricted as per the IMS Act, 1992 and
Nutraceutical regulations, as applicable.
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 NOC by Municipality/Panchayat view
3 Photographs of the unit (Entrance/Front facing end of the unit) view
4 Copy of agreement with the Direct Selling Entity view
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 24-05-2025 2121778517110351 pay_QYgclMxRH9Fw4r 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
Page 2 of 3
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
Date & Time : 24-05-2025 13:07:41 IST
Applicant Name : HARSH NARESH AGRWAL
Verified through Aadhar : 62XXXXXXXX15
IP Address : [Link]
Page 3 of 3