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: 30210710108345330 Application Type: New Registration
Name of Applicant / VEG CARE Application Date: 10-07-2021
Company: RESTAURANT Kind of Business: Restaurants
Designation: Proprieter
Address of Premises Where Food Business Is Located
Address: BALAGANDI State: Orissa
CHHAK GRAND
Sub-Division/Station/ Ward 17
ROAD
Division(Railways):
District/Region/Zone: PURI Pin Code: 752001
MUNICIPALITY
Village: Grand road
Nearest Landmark: N/A
Correspondence Address Details
Address: BALAGANDI State: Orissa
CHHAK GRAND Sub-Division/Station/ Ward 17
ROAD Division(Railways):
District/Region/Zone: PURI Pin Code: 752001
MUNICIPALITY
Village: Grand road
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8917523236 Email-ID: N/A
Contact Person: GOPINATH SAHOO
Other Details
In case of New business – intended date of start: N/A
Source of Water Supply: N/A
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
Sl. No Food Item(s)
1 16 - Prepared Foods
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
Payment Details
S.No. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 10-07-2021 4400632838956542 pay_HXASE3HKMXmxth 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 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.
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