Food Safety Compliance System (FoSCoS)
[Link]
Form A
[See Regulation 2.1.1, Regulation 2.1.7]
Application for Registration under food safety and Standards Act,2006
Application No: 30250729120921533 Application Type: New Registration
Name of Applicant / imran Application Date: 29-07-2025
Company: Kind of Business: Food Services - Petty
Designation: Individual Retailer of snacks/tea
shops
Address of Premises Where Food Business Is Located
Address: shekhjadgan ward State: Uttar Pradesh
10 kandhla
Sub-Division/Station/ Kairana
District/Region/Zone: Shamali Division:
Village: Kandhala Pan No: N/A
Pin Code: 247775
Nearest Landmark: phoons wali
masjid
Correspondence Address Details
Address: shekjadgan ward State: Uttar Pradesh
14 kandhla shamli Sub-Division/Station/ Kairana
District/Region/Zone: Shamali Division:
Village: Kandhala Pin Code: 247775
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9548059487 Email-ID: N/A
Contact Person: 9548059487 Aadhaar No: 80XXXXXXXX78
Other Details
In case of New business – intended date of start: 29-07-2025
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.]
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Other than Manufacturer Unit
Sl. No Name of the food category
1 12 - Salts, spices, soups, sauces, salads and protein products
2 10 - Eggs and egg products
3 01 - Dairy products and analogues, excluding products of food category 2.0
4 07 - Bakery products
5 05 - Confectionery
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Identity Proof - Aadhar Card View
2 Photo View
Other Document(s) Details
[Link]. Documents Description Uploaded Document
1 Photographs of the unit (Entrance/Front facing end of the unit) view
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 29-07-2025 660225644295157 pay_QyplZrL3Chv2EB 100.00
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
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
Date & Time : 29-07-2025 [Link] IST
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Applicant Name : imran
Verified through Aadhar : 80XXXXXXXX78
IP Address : [Link]
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