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: 30250612120374483 Application Type: New Registration
Name of Applicant / M/S SHABNOOR S/O Application Date: N/A
Company: KHALEEL Kind of Business: Food Services - Hawker
Designation: Proprieter (Itinerant / Mobile
food vendor)
Address of Premises Where Food Business Is Located
Address: MODINAGAR, State: Uttar Pradesh
GHAZIABAD
Sub-Division/Station/ Nagar Palika
District/Region/Zone: Ghaziabad Division(Railways): Modinagar
Village: Modinagar (NPP) Pan No: NAPPS2578D
Pin Code: 245304 Name: SHABNOOR
Nearest Landmark: N/A DOB: 01-01-1995
Gender: MALE
Correspondence Address Details
Address: S/O KHALEEL, State: Uttar Pradesh
HOUSE, NHALI, Sub-Division/Station/ Nagar Palika
HAPUR ROAD, Division(Railways): Modinagar
NAHALI,
Pin Code: 245304
GHAZIABAD
District/Region/Zone: Ghaziabad
Village: Modinagar (NPP)
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 7983995349 Email-ID: N/A
Contact Person: SHABNOOR
Other Details
In case of New business – intended date of start: N/A
Source of Water Supply: N/A
Sanction Electricity Load or HP Used: No
Number of years applied for: 5
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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 01 - Dairy products and analogues, excluding products of food category 2.0
2 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
3 14 - Beverages, excluding dairy products
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Photo View
2 Identity Proof - Aadhar Card View
Other Document(s) Details
[Link]. Documents Description Uploaded Document
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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