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: 30260120123021389 Application Type: New Registration
Name of Applicant / ABDUL KALEEM C/O Application Date: N/A
Company: GOLDEN TRADING Kind of Business: Trade/Retail -
COMPANY Wholesaler
Designation: Individual
Address of Premises Where Food Business Is Located
Address: #93 ward no 13, State: Karnataka
kotegiri 1st cross,
Sub-Division/Station/ Bellary
court mohalla,
Division:
millerpet bellary
hagaribommanahal Pan No: AHXPA2957Q
li Name: ABDUL KALEEM
District/Region/Zone: Bellary DOB: 10-01-1982
Village: Bellary[R] Gender: MALE
Pin Code: 583101
Nearest Landmark: N/A
Correspondence Address Details
Address: #93 ward no 13, State: Karnataka
kotegiri 1st cross, Sub-Division/Station/ Bellary
court mohalla, Division:
millerpet bellary
Pin Code: 583101
hagaribommanahal
li
District/Region/Zone: Bellary
Village: Bellary[R]
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8548938391 Email-ID: KALEEMASMI123@GMA
Contact Person: ABDUL KALEEM [Link]
Aadhaar No: 89XXXXXXXX47
Other Details
In case of New business – intended date of start: N/A
Page 1 of 2
Source of Water Supply: N/A
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. No Name of the food category
1 01 - Dairy products and analogues, excluding products of food category 2.0
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 Photographs of the unit (Entrance/Front facing end of the unit) 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