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: 30240621116847966 Application Type: New Registration
Name of Applicant / Sadhishkumar Application Date: 25-06-2024
Company: Kind of Business: Food Services -
Designation: Individual Restaurants
Address of Premises Where Food Business Is Located
Address: 2, Rajeshwari State: Tamil Nadu
nagar, Villupuram-
Sub-Division/Station/ Villupuram Mpty
pondy main road,
Division(Railways):
kandamangalam
Pin Code: 605102
District/Region/Zone: Viluppuram
Pan No: LFOPS9361E
Village: N/A
Nearest Landmark: Sri balaji door
world opposite
Correspondence Address Details
Address: 100, Mariyamman State: Puducherry
koil street, Sub-Division/Station/ Puducherry- Rural
karikkalampakkam Division(Railways):
District/Region/Zone: Puducherry Pin Code: 605007
Village: KARIKALAMPAKKA
M
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8680078015 Email-ID:
[email protected]Contact Person: Sadhishkumar
Other Details
In case of New business – intended date of start: 01-07-2024
Source of Water Supply: Public
Sanction Electricity Load or HP Used: No
Number of years applied for: 1
Detail(s) of Food Item
Page 1 of 3
[Note:Only standardised food products are allowed to be manufactured as per the list available on FoSCoS.]
Other than Manufacturer Unit
Sl. Name of the food category
No
1 10 - Eggs and egg products
2 16 - Prepared Foods
3 12 - Salts, spices, soups, sauces, salads and protein products
4 08 - Meat and meat products, including poultry and game
5 09 - Fish and fish products, including molluscs, crustaceans, and echinoderms
6 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
7 99 - Substances added to food
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
No Record Found
S.No. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 25-06-2024 2037962215989674 pay_OQsxo6l6ZMhv1h 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.
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Declaration || Condition of License || Inspection Checklist
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
Date & Time : 25-06-2024 11:21:49 IST
Applicant Name : Sadhishkumar
Verified through Mobile : 86XXXXXX15
IP Address : 117.196.159.233
Page 3 of 3
