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: 30250104118677662 Application Type: Modification
Name of Applicant / MUTHALVAR Application Date: 04-01-2025
Company: MARUNTHAGAM C/O Kind of Business: Trade/Retail - Retailer
A.3099 TNSTC
Certificate No: 22424577000169
WORKER'S CO-
OPERATIVE STORE
LTD
Designation: Co-operative Society
Expiry Date: 26-12-2025
Address of Premises Where Food Business Is Located
Address: 27 BYEPASS ROAD State: Tamil Nadu
PASUMPON
Sub-Division/Station/ Madurai Corporation
NAGAR
Division(Railways): Ward-76
PALAGANATHAM ,M
ADURAI-625003 Pan No: DJZPB9574H
Name: BOOMINATHAN
District/Region/Zone: Madurai
DOB: 13-06-1969
Village: Madurai
Corporation Gender: MALE
Ward-76
Pin Code: 625003
Nearest Landmark: MDCC BANK
Correspondence Address Details
Address: 27 BYEPASS ROAD State: Tamil Nadu
PASUMPON Sub-Division/Station/ Madurai Corporation
NAGAR Division(Railways): Ward-76
PALAGANATHAM ,M
Pin Code: 625003
ADURAI-625003
District/Region/Zone: Madurai
Village: Madurai
Corporation
Ward-76
Contact Details
Telephone No: 8248898071 Fax: N/A
Mobile No: 8248898071 Email-ID: tnstcwcs@[Link]
Contact Person: BOOMINATHAN Aadhaar No: 48XXXXXXXX64
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Other Details
In case of New business – intended date of start: 27-12-2024
Source of Water Supply: Public
Sanction Electricity Load or HP Used: No
Number of years applied for: 1
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 02 - Fats and oils, and fat emulsions
2 01 - Dairy products and analogues, excluding products of food category 2.0
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 99 - Substances added to food
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
1 Proof of Premises view
2 Photographs of the unit (Entrance/Front facing end of the unit) view
[Link]. Mode Of Payment Payment Date Transcation Number Amount
1 PayUBiz 04-01-2025 495955522759525 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,
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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
Date & Time : 04-01-2025 17:33:05 IST
Applicant Name : MUTHALVAR MARUNTHAGAM C/O A.3099 TNSTC WORKER'S CO-
OPERATIVE STORE LTD
Verified through 82XXXXXX71
Mobile :
IP Address : [Link]
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