Food Safety Compliance System (FoSCoS)
https://foscos.fssai.gov.in
Form B
[See Regulation 2.1.2, Regulation 2.1.3, Regulation 2.1.7]
Application for Licenses / Renewal of license under food safety and Standards
Act,2006
Application Reference No: 20241030106617303 Application Type: New License
Name of Company/ M A FOODS Application Date: N/A
Organizations: Kind of Business: Trade/Retail -
Address: 77/97 COOLIE Wholesaler
BAZAR, NAGAR Trade/Retail -
NIGAM FOOD Distributor
SAFETY ZONE-03, Trade/Retail -
Kanpur Nagar, Uttar Transportation (having
Pradesh-208001 a number of
PAN No: BRVPA8279C specialized vehicles
like insulated
Name: MOHD AMIR
refrigerated van/
DOB: 14-02-1992 wagon and milk
Gender: MALE tankers etc.)
GST No: Not Provided
CIN No: Not provided
Port Name: N/A
Registered Office Detail(s)
Address: 77/97 COOLIE State: Uttar Pradesh
BAZAR Pin Code: 208001
District : Kanpur Nagar
Address of Premises for which license is applied
Address: 77/97 COOLIE State: Uttar Pradesh
BAZAR Pin Code: 208001
District : Kanpur Nagar
Sub-Division : NAGAR NIGAM
FOOD SAFETY
ZONE-03
Correspondence Address
Address: 77/97 COOLIE State: Uttar Pradesh
BAZAR Pin Code: 208001
District : Kanpur Nagar
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Contact Information
Telephone No: N/A Fax: N/A
Mobile No: 9651111118 Email-ID: mohammadaamirqurai
[email protected]Person in charge of operations
Name: MOHD AMIR Qualification: GRADUATION
Contact No: N/A Mobile No: 9651111118
Email-ID: mohammadaamirqu Address: 77/97 COOLIE BAZAR
[email protected] District: Kanpur Nagar
State: Uttar Pradesh Photo Id Card: Aadhar Card
Pin Code: 208001
Photo ID Expiry Date: N/A
Photo ID No: 960791246183
FoSTaC No: N/A
Trainee Name: N/A
FoSTac Validity End Date: N/A
Person responsible for complying with conditions of License (The person must be same as mentioned
in Form IX, as per FSS Regulations, 2011)
Name: MOHD AMIR Qualification: GRADUATION
Contact No: N/A Mobile No: 9651111118
Email-ID: mohammadaamirqu Address: 77/97 COOLIE BAZAR
[email protected] District: Kanpur Nagar
State: Uttar Pradesh Photo Id Card: Aadhar Card
Pin Code: 208001
Photo ID Expiry Date: N/A
Photo ID No: 960791246183
Number of years applied for: 1
Kind Of Business: Trade/Retail - Wholesaler
Sl.No. Food Product Category
1 08 - Meat and meat products, including poultry and game
Kind Of Business: Trade/Retail - Distributor
Sl.No. Food Product Category
1 08 - Meat and meat products, including poultry and game
Kind Of Business: Trade/Retail - Transportation (having a number of specialized vehicles like
insulated refrigerated van/ wagon and milk tankers etc.)
Sl.No. Food Product Category
1 08 - Meat and meat products, including poultry and game
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Other Detail(s)
Whether Unit is Equipped with an analytical laboratory ? :No
Already Holding License: No
Other License: No
Is Holding PA/NOC: No
Document(s) Details
S.No. Documents Submission Document
Type Uploaded/FBO
Remarks
1 List of Directors/Partners/Proprietor/ExecutiveMembers of Society/ Mandatory view
Trust with full address and contact details with nomination of
authorized signatory * View Sample Document
2 Photo I.D and address proof issued by Government authority of Mandatory view
Proprietor/Partner/Director(s)/Authorised Signatory. View Sample
Document
3 Proof of possession of premises. (Sale deed/ Rent agreement/ Mandatory view
Electricity bill, etc.) View Sample Document
4 Partnership Deed/ Self Declaration for Proprietorship/ Mandatory view
Memorandum & Articles of Association towards the constitution of
the firm / Copy of certificate obtained under Coop Act-1861/ Multi
State Coop Act-2002 in case of Cooperative View Sample
Document
5 Form IX: Nomination of Person as per Clause 2.5of FSS Rules, 2008 N/A N/A
(Not applicable in case of Proprietor) Click here to Download
Sample Document in English | Click here to Download Sample
Document in Hindi *
6 List of Vehicle Registration numbers * Mandatory view
Other Document(s) Details
S.No. Documents Description Document Uploaded/FBO Remarks
N/A
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 have food safety plan to ensure that articles of food mentioned in form satisfy the requirements of FSS
Act 2006 and Rules and Regulations made thereunder.
Our facility 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.
I/We shall abide with all conditions of License.
Expected capacity of the business is to the best of my knowledge. I/We will modify our License as and when
our eligibility in the mentioned criteria for License changes.
I will be responsible for Permissions/No Objection Certificates from other Govt. bodies wherever required.
I/We have complied with all the permissions/rules, which are applicable to my food business and the
premises of the food business such as CGWA NOC etc.
I/We do not possess more than one active license/ registration for any other food business(es) at the same
premises.
I have read/understood the punishment provision under Section 61 of FOOD SAFETY AND STANDARDS ACT,
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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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