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: 30231115114968316 Application Type: New Registration

Name of Applicant / SUKRI PREMIUM Application Date: N/A
Company: Kind of Business: Trade/Retail - Retailer
Designation: Individual

Address of Premises Where Food Business Is Located

Address: RATHODI MLAD State: Maharashtra

EAST
Sub-Division/Station/ Greater Mumbai Ward-
District/Region/Zone: Greater Mumbai Division(Railways): R/C
Village: Borivali Pin Code: 400095
Nearest Landmark: KAMAL TALAW Pan No: N/A
BUS STOP

Correspondence Address Details

Address: RATHODI MLAD State: Maharashtra

EAST Sub-Division/Station/ Greater Mumbai Ward-
District/Region/Zone: Greater Mumbai Division(Railways): R/C
Village: Borivali Pin Code: 400095

Contact Details

Telephone No: N/A Fax: N/A

Mobile No: 8858285677 Email-ID: ykanhaiya957@gmail.
Contact Person: krishnanand yadav com

Other Details

In case of New business – intended date of start: 20-11-2023

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.]

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 Other then Manufacturer Unit
Sl. Name of the food category
No
1 07 - Bakery products
2 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
3 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 - Pan Card View

Other Document(s) Details

S.No. Documents Description Uploaded Document

No Record Found

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. 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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