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: 30250927121660582 Application Type: Renewal
Name of Applicant / POOJA Application Date: N/A
Company: Kind of Business: Trade/Retail - Retailer
Designation: Individual Certificate No: 22724894000091
Expiry Date: 24-09-2025
Address of Premises Where Food Business Is Located
Address: THAKURDWARA , State: Uttar Pradesh
POST MADHAULI
Sub-Division/Station/ Nagar Palika Zone 3
District/Region/Zone: Rampur Division(Railways):
Village: Ward No.15 Pan No: N/A
Pin Code: 244901
Nearest Landmark: N/A
Correspondence Address Details
Address: POOJA W/O State: Uttar Pradesh
LOKESH , Sub-Division/Station/ Nagar Palika Zone 3
THAKURDWARA , Division(Railways):
POST MADHAULI
Pin Code: 244901
District/Region/Zone: Rampur
Village: Ward No.15
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9917249123 Email-ID: N/A
Contact Person: POOJA
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: 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. No Name of the food category
1 13 - Foodstuffs intended for particular nutritional uses
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 fassai certificate 22724894000091 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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