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: 30250918121538316 Application Type: New Registration
Name of Applicant / Jubinraj Babul Application Date: N/A
Company: Khataniar Kind of Business: Food Services - Food
Designation: Proprieter Vending Establishment
Address of Premises Where Food Business Is Located
Address: Gharamara, State: Assam
Kamrup
Sub-Division/Station/ Kamrup Metropolitan
District/Region/Zone: Kamrup Division(Railways): Dist
Metropolitan Dist. Pan No: KZMPK2683C
Village: Hatigaon Name: JUBINRAJ BABUL
Pin Code: 781040 KHATANIAR
Nearest Landmark: GEETANJALI DOB: 16-10-2002
APARTMENT Gender: MALE
Correspondence Address Details
Address: Gharamara, State: Assam
Kamrup Sub-Division/Station/ Kamrup Metropolitan
District/Region/Zone: Kamrup Division(Railways): Dist
Metropolitan Dist. Pin Code: 781040
Village: Hatigaon
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 7099425932 Email-ID: khataniarjubin@gmail
Contact Person: Jubinraj .com
Aadhaar No: 26XXXXXXXX65
Other Details
In case of New business – intended date of start: 01-10-2025
Source of Water Supply: Private
Sanction Electricity Load or HP Used: No
Number of years applied for: 1
Detail(s) of Food Item
Page 1 of 2
[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 16 - Prepared Foods
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 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
Page 2 of 2