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Food Safety Registration Application Form

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by M/S Sonu Dairy, owned by Jahid, for a food services business as an itinerant vendor in Modinagar, Uttar Pradesh. The application includes details about the business location, contact information, food categories intended for sale, and a declaration of compliance with food safety regulations. The applicant has provided identity proof and a photo, and affirms the accuracy of the information provided.

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0% found this document useful (0 votes)
11 views2 pages

Food Safety Registration Application Form

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by M/S Sonu Dairy, owned by Jahid, for a food services business as an itinerant vendor in Modinagar, Uttar Pradesh. The application includes details about the business location, contact information, food categories intended for sale, and a declaration of compliance with food safety regulations. The applicant has provided identity proof and a photo, and affirms the accuracy of the information provided.

Uploaded by

suhailtomer79
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: 30250612120366043 Application Type: New Registration


Name of Applicant / M/S SONU DAIRY, Application Date: N/A
Company: JAHID S/O IKBAL 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: BCMPJ1256J
Pin Code: 245304 Name: JAHID
Nearest Landmark: N/A DOB: 01-01-1985
Gender: MALE

Correspondence Address Details

Address: S/O IKBAL, HOUSE State: Uttar Pradesh


NAHALI, HAPUR Sub-Division/Station/ Nagar Palika
ROAD, NAHALI, Division(Railways): Modinagar
PILKHAUWA,
Pin Code: 245304
GHAZIABAD
District/Region/Zone: Ghaziabad
Village: Modinagar (NPP)

Contact Details

Telephone No: N/A Fax: N/A


Mobile No: 9690641786 Email-ID: N/A
Contact Person: JAHID

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

Page 1 of 2
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 05 - Confectionery
4 07 - Bakery products
5 14 - Beverages, excluding dairy products

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


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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