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Application

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by Jai Linendra for a food business located in Bangalore, Karnataka. The application includes details about the applicant, business type, contact information, intended start date, and food items to be handled. The applicant declares compliance with all relevant regulations and acknowledges the penalties for providing false information.

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ranganath126
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7 views

Application

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by Jai Linendra for a food business located in Bangalore, Karnataka. The application includes details about the applicant, business type, contact information, intended start date, and food items to be handled. The applicant declares compliance with all relevant regulations and acknowledges the penalties for providing false information.

Uploaded by

ranganath126
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
You are on page 1/ 2

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: 30250115118786125 Application Type: New Registration


Name of Applicant / JAI LINENDRA Application Date: N/A
Company: MARKETING Kind of Business: Trade/Retail -
Designation: Proprieter Wholesaler

Address of Premises Where Food Business Is Located

Address: 15/83,1ST MAIN State: Karnataka


ROAD,
Sub-Division/Station/ Malleshwaram
OKALIPURAM,
Division(Railways):
BANGALORE-56002
1 Pan No: AHYPJ5642C
Name: VINOD KUMAR
District/Region/Zone: B.B.M.P North
BHERAMAL JAIN
Village: N/A
DOB: 30-04-1987
Pin Code: 560021
Gender: MALE
Nearest Landmark: NEAR
MAHADESWAR
BHAVAN

Correspondence Address Details

Address: 15/83,1ST MAIN State: Karnataka


ROAD, Sub-Division/Station/ Malleshwaram
OKALIPURAM, Division(Railways):
BANGALORE-56002
Pin Code: 560021
1
District/Region/Zone: B.B.M.P North
Village: N/A

Contact Details

Telephone No: N/A Fax: N/A


Mobile No: 9022585566 Email-ID: VINODJAIN5740@GMA
Contact Person: VINOD KUMAR IL.COM
Aadhaar No: 33XXXXXXXX78

Other Details

In case of New business – intended date of start: 15-01-2025


Source of Water Supply: Private

Page 1 of 2
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 14 - Beverages, excluding dairy products

Document(s) Details

S.No. Documents Description Uploaded Document

Other Document(s) Details

S.No. 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

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