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: 30220603110747523 Application Type: Modification
Name of Applicant / SHRIKANT Application Date: 03-06-2022
Company: TULSHIRAM DAL / Kind of Business: Trade/Retail -
YASH ENTERPRISES Distributor
Designation: Proprieter Certificate No: 21521185000807
Expiry Date: 03-09-2026
Address of Premises Where Food Business Is Located
Address: Shop no. k-71, C- State: Maharashtra
WING, LOKMANYA
Sub-Division/Station/ Greater Mumbai Ward-
PAN BAZAAR,
Division(Railways): L
EVERAD NAGAR,
sion Pan No: N/A
District/Region/Zone: Greater Mumbai
Village: Kurla Gaon
Pin Code: 400022
Nearest Landmark: Eastern express
highway
Correspondence Address Details
Address: Shop no. k-71, C- State: Maharashtra
WING, LOKMANYA Sub-Division/Station/ Greater Mumbai Ward-
PAN BAZAAR, Division(Railways): L
EVERAD NAGAR,
Pin Code: 400022
sion
District/Region/Zone: Greater Mumbai
Village: Kurla Gaon
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9987279030 Email-ID: Shrikantdal1989@gmai
Contact Person: SHRIKANT [Link]
TULSHIRAM DAL
Other Details
In case of New business – intended date of start: 26-08-2021
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Source of Water Supply: N/A
Sanction Electricity Load or HP Used: No
Number of years applied for: 5
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 18- Indian Sweets and Indian Snacks & Savouries products
2 14 - Beverages, excluding dairy products
3 05 - Confectionery
4 11 - Sweeteners, including honey
5 02 - Fats and oils, and fat emulsions
6 15 - Ready-to-eat savouries
7 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
8 07 - Bakery products
9 05 - Confectionery
10 08 - Meat and meat products, including poultry and game
11 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
12 01 - Dairy products and analogues, excluding products of food category 2.0
13 14 - Beverages, excluding dairy products
14 03 - Edible ices, including sherbet and sorbe
15 16 - Prepared Foods
16 13 - Foodstuffs intended for particular nutritional uses
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
2 Proof of Premises view
3 Aadhar Card view
4 GST CERTIFICATE view
5 Electricity bill view
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[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 03-06-2022 5143319206367243 pay_JcvooZvlpNCoSd 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,
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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