Food Safety Compliance System (FoSCoS)

https://foscos.fssai.gov.in
Form A
[See Regulation 2.1.1, Regulation 2.1.7]

Application for Registration under food safety and Standards Act,2006

Application No: 30240302115925377 Application Type: New Registration

Name of Applicant / AKSHITA'S FAST Application Date: N/A
Company: FOOD /MANJU Kind of Business: Food Services -
TIWARI Restaurants
Designation: Individual

Address of Premises Where Food Business Is Located

Address: SHOP NO 218/2 State: Madhya Pradesh

INAYATPUR NEAR
Sub-Division/Station/ Bhopal
PUMP HOUSE
Division(Railways):
KOLAR ROAD
BHOPAL Pin Code: 462042
Pan No: N/A
District/Region/Zone: Bhopal
Village: Bhopal
Nearest Landmark: N/A

Correspondence Address Details

Address: 218 INAYATPUR State: Madhya Pradesh

KOLAR Sub-Division/Station/ Bhopal
BAIRAGADH Division(Railways):
CHICHLI
Pin Code: 462042
INAYATPUR
BHOPAL
District/Region/Zone: Bhopal
Village: Bhopal

Contact Details

Telephone No: N/A Fax: N/A

Mobile No: 7880089880 Email-ID: manjutiwari7@yahoo.
Contact Person: MANJU TIWARI com

Other Details

In case of New business – intended date of start: 02-03-2024

Source of Water Supply: N/A
Sanction Electricity Load or HP Used: No
Number of years applied for: 5

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 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 16 - Prepared Foods
2 18- Indian Sweets and Indian Snacks & Savouries products

Document(s) Details

S.No. Documents Description Uploaded Document

1 Identity Proof - Aadhar Card View
2 Photo View

Other Document(s) Details

S.No. Documents Description Uploaded Document

1 RENT AGREEMENT 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. Punishment 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 punishable with imprisonment for a term which may extend to three months and also with fine
which may extend to two 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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