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Application

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by IMA Kerala - Doctors Club for a food services business. The application includes details such as the business address, contact information, food categories intended for service, and a declaration of compliance with food safety regulations. The applicant has provided identity proof and a photo, affirming that all information is accurate and acknowledging the penalties for false information.

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dadfoodfactory
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7 views

Application

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by IMA Kerala - Doctors Club for a food services business. The application includes details such as the business address, contact information, food categories intended for service, and a declaration of compliance with food safety regulations. The applicant has provided identity proof and a photo, affirming that all information is accurate and acknowledging the penalties for false information.

Uploaded by

dadfoodfactory
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: 30240826117437799 Application Type: New Registration


Name of Applicant / IMA KERALA Application Date: N/A
Company: DOCTORS CLUB Kind of Business: Food Services - Petty
Designation: Individual Retailer of snacks/tea
shops, Food Services -
Hawker (Itinerant /
Mobile food vendor)

Address of Premises Where Food Business Is Located

Address: IMA HQ, ANAYARA State: Kerala

District/Region/Zone: Thiruvananthapur Sub-Division/Station/ Thiruvananthapuram


am Division: Circle
Village: N/A Pin Code: 695029
Nearest Landmark: OPP ARIYAS Pan No: N/A
RESTOURANT

Correspondence Address Details

Address: IMA HQ, ANAYARA State: Kerala


District/Region/Zone: Thiruvananthapur Sub-Division/Station/ Thiruvananthapuram
am Division: Circle
Village: N/A Pin Code: 695029

Contact Details

Telephone No: N/A Fax: N/A


Mobile No: 7306881914 Email-ID: N/A
Contact Person: AJO

Other Details

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


Source of Water Supply: Public
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
Other than Manufacturer Unit
Sl. No Name of the food category
1 16 - Prepared Foods
2 10 - Eggs and egg products
3 14 - Beverages, excluding dairy 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


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. 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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