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Application

Uploaded by

Neha sherin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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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: 30230605113612058 Application Type: New Registration


Name of Applicant / BUSHRA SM Application Date: N/A
Company: Kind of Business: Manufacturer -
Designation: Individual General
Manufacturing

Address of Premises Where Food Business Is Located

Address: HAMD State: Kerala


PANNIYANNUR
Sub-Division/Station/ Thalassery Circle
District/Region/Zone: Kannur Division(Railways):
Village: N/A Pin Code: 670671
Nearest Landmark: PANNIYANNUR Pan No: N/A

Correspondence Address Details

Address: HAMD State: Kerala


PANNIYANNUR Sub-Division/Station/ Thalassery Circle
District/Region/Zone: Kannur Division(Railways):
Village: N/A Pin Code: 670671

Contact Details

Telephone No: N/A Fax: N/A


Mobile No: 9496409506 Email-ID: [email protected]
Contact Person: BUSHRA SM

Other Details

In case of New business – intended date of start: N/A


Source of Water Supply: Private
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.]

Page 1 of 2
Manufacturer Unit
Sl.No. Food Category Sub-Food Category Product Kind of
Business
1 07 - Bakery 07.1 - Bread and ordinary bakery Bread and Bread-Type Manufacturer
products wares and mixes Products [07.1.1]

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


No Record Found

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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