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: 20240205105600561 Application Type: New License
Name of Company/ GALAXYVIEW HOTEL Application Date: N/A
Organizations: PVT LTD Kind of Business: Food Services - Hotel
GST No: 09AAFCG0547C1ZX CIN No: Not provided
Address: 218E/71 M.G. MARG Port Name: N/A
CIVIL LINES,
Allahabad Tahsil,
Prayagraj, Uttar
Pradesh-209601
PAN No: Not Provided
Registered Office Detail(s)
Address: 218E/71 M.G. State: Uttar Pradesh
MARG CIVIL LINES Pin Code: 209601
District : Prayagraj
Address of Premises for which license is applied
Address: 218E/71 M.G. State: Uttar Pradesh
MARG CIVIL LINES Pin Code: 209601
District : Prayagraj
Sub-Division : Allahabad Tahsil
Correspondence Address
Address: 1-D Beli Road, New State: Uttar Pradesh
Katra Pin Code: 211002
District : Prayagraj
Contact Information
Telephone No: N/A Fax: N/A
Mobile No: 9918901686 Email-ID: adityacse1996@gmail.
com
Person in charge of operations
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Name: SIDDHANT JAIN Qualification: GRADUATE
Contact No: N/A Mobile No: 9161411111
Email-ID: adityacse1996@gm Address: 1-D Beli Road, New
ail.com Katra, Dahiawan,
State: Uttar Pradesh Allahabad Kty
Pin Code: 211002 District: Prayagraj
Photo ID No: 9128321334046121 Photo Id Card: Aadhar Card
FoSTaC No: N/A Photo ID Expiry 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: SIDDHANT JAIN Qualification: GRADUATE
Contact No: N/A Mobile No: 9161411111
Email-ID: adityacse1996@gm Address: 1-D Beli Road, New
ail.com Katra, Dahiawan,
State: Uttar Pradesh Allahabad Kty
Pin Code: 211002 District: Prayagraj
Photo ID No: 9128321334046121 Photo Id Card: Aadhar Card
Number of years applied for: 5 Photo ID Expiry Date: N/A
Kind Of Business: Food Services - Hotel
Sl.No. Product(s)
1 06 - Cereals and cereal products, derived from cereal grains, from roots and tubers, pulses, legumes
and pith or soft core of palm tree, excluding bakery wares of food category 7.0
2 12 - Salts, spices, soups, sauces, salads and protein products
3 13 - Foodstuffs intended for particular nutritional uses
4 16 - Prepared Foods
5 99 - Substances added to food
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 Analysis report(Chemical & Bacteriological)of water to be used as N/A N/A
ingredient in food from a recognized/ public health laboratory to
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S.No. Documents Submission Document
Type Uploaded/
FBO Remarks
confirm the potability indicating the name of authorized
representative of Lab who collected the sample and date of collecting
sample. (Not Applicable if water is not being used as ingredient)
View Sample Document,
3 Photo I.D and address proof issued by Government authority of Mandatory view
Proprietor/ Partner/ Director(s)/ Authorised Signatory. View Sample
Document
4 Proof of possession of premises. (Sale deed/ Rent agreement/ Mandatory view
Electricity bill, etc.) View Sample Document
5 Partnership Deed/ Self Declaration for Proprietorship/ Memorandum Mandatory view
& 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
6 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 *
Other Document(s) Details
S.No. Documents Description Document Uploaded/FBO Remarks
1 Water Test Report 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 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,
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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