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: 30250805121016637 Application Type: New Registration
Name of Applicant / UMESH YALIGAR Application Date: 04-09-2025
Company: Kind of Business: Trade/Retail - Retailer
Designation: Individual
Address of Premises Where Food Business Is Located
Address: No 2, 1st Main State: Karnataka
Tent road,
Sub-Division/Station/ K R Puram
Devasandra Rajiv
Division:
Gandhi nagar
Pan No: APYPY0020K
District/Region/Zone: B.B.M.P East
Name: UMESH YALIGAR
Village: N/A
DOB: 04-03-1998
Pin Code: 560036
Gender: MALE
Nearest Landmark: Venkateshwara
theater
Correspondence Address Details
Address: [Link] 2243 Ganpat State: Karnataka
Galli, Peeranwadi. Sub-Division/Station/ Belgaum
District/Region/Zone: Belgaum Division:
Village: PEERANWADI Pin Code: 590014
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 7760260253 Email-ID: [Link]@gmail.
Contact Person: UMESH YALIGAR com
Aadhaar No: 85XXXXXXXX32
Other Details
In case of New business – intended date of start: 05-09-2025
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 3
[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 14 - Beverages, excluding dairy products
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Photo - Aadhar Card 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 Razorpay ID Amount
1 Razorpay 04-09-2025 139407030960456 pay_RDSpSb4unRQeFg 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
Date & Time : 04-09-2025 14:17:20 IST
Applicant Name : UMESH YALIGAR
Page 2 of 3
Verified through Aadhar : 85XXXXXXXX32
IP Address : [Link]
Page 3 of 3