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: 30250731120944164 Application Type: New Registration
Name of Applicant / Zaayka-e-Ghar Application Date: N/A
Company: Kind of Business: Food Services -
Designation: Individual Restaurants
Address of Premises Where Food Business Is Located
Address: New Madhopuri State: Uttar Pradesh
Colony Kasganj
Sub-Division/Station/ Kasganj Tahsil
District/Region/Zone: Kasganj Division(Railways):
Village: Kasganj Pan No: CHQPJ7037R
Pin Code: 207123 Name: AMAR PRAKASH
Nearest Landmark: N/A JOHARI
DOB: 18-04-2003
Gender: MALE
Correspondence Address Details
Address: New Madhopuri State: Uttar Pradesh
Colony Kasganj Sub-Division/Station/ Kasganj Tahsil
District/Region/Zone: Kasganj Division(Railways):
Village: Kasganj Pin Code: 207123
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9756154643 Email-ID: amarjohari8273@gmai
Contact Person: Amar Prakash [Link]
Johari Aadhaar No: 74XXXXXXXX60
Other Details
In case of New business – intended date of start: N/A
Source of Water Supply: Private
Sanction Electricity Load or HP Used: No
Number of years applied for: 1
Detail(s) of Food Item
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[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 12 - Salts, spices, soups, sauces, salads and protein products
2 14 - Beverages, excluding dairy products
3 03 - Edible ices, including sherbet and sorbe
4 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
5 16 - Prepared Foods
6 18- Indian Sweets and Indian Snacks & Savouries products
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Identity Proof - Pan Card View
2 Photo View
Other Document(s) Details
[Link]. Documents Description Uploaded Document
1 Proof of Premises view
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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