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Application

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by Poori House for food services in Lucknow, Uttar Pradesh. The application includes details about the business, food items intended for sale, and compliance with food safety regulations. The applicant has declared compliance with all relevant provisions and has provided necessary documentation and payment information.

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COO Jagjit Auto Ancillaries
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17 views

Application

The document is an application for registration under the Food Safety and Standards Act, 2006, submitted by Poori House for food services in Lucknow, Uttar Pradesh. The application includes details about the business, food items intended for sale, and compliance with food safety regulations. The applicant has declared compliance with all relevant provisions and has provided necessary documentation and payment information.

Uploaded by

COO Jagjit Auto Ancillaries
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/ 3

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: 30211228109495895 Application Type: New Registration


Name of Applicant / Poori House Application Date: 29-12-2021
Company: Kind of Business: Food Services -
Designation: Individual Restaurants

Address of Premises Where Food Business Is Located

Address: Shop no-4,34, State: Uttar Pradesh


Nawal Kishore
Sub-Division/Station/ Nagar Nigam Food
Road,Lucknow-226
Division(Railways): Safety Zone-2
001
Pan No: N/A
District/Region/Zone: Lucknow
Village: HAZRATGANJ
Pin Code: 226001
Nearest Landmark: Near Ram Ashrey

Correspondence Address Details

Address: C\O Arun Kumar State: Uttar Pradesh


Dixit,90- Sub-Division/Station/ Sidhauli Tahsil
Bambhaura Post Division(Railways):
Sidhaule,
Pin Code: 261141
District/Region/Zone: Sitapur
Village: Bambhaura

Contact Details

Telephone No: N/A Fax: N/A


Mobile No: 7054101515 Email-ID: N/A
Contact Person: Prashant Dixit

Other Details

In case of New business – intended date of start: 01-01-2022


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

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 16 - Prepared Foods
2 18- Indian Sweets and Indian Snacks & Savouries products
3 15 - Ready-to-eat savouries
4 07 - Bakery products
5 99 - Substances added to food
6 12 - Salts, spices, soups, sauces, salads and protein 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 Proof of Premises view

S.No. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount


1 Razorpay 29-12-2021 57983796553551 pay_IdDKL5ROW0qXpZ 500.00

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

Page 2 of 3
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची

Page 3 of 3

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