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: 30250125118919304 Application Type: Renewal
Name of Applicant / Shital Prasad s/o Application Date: N/A
Company: Govind Chand Kind of Business: Trade/Retail - Retailer
Designation: Individual Certificate No: 22722178000039
Expiry Date: 01-03-2025
Address of Premises Where Food Business Is Located
Address: Sabarhad Beraicha State: Uttar Pradesh
Bojhi Bazar Po-
Sub-Division/Station/ Ghosi Tahsil
Bojhi
Division(Railways):
District/Region/Zone: Mau Pan No: N/A
Village: Amila
Pin Code: 275301
Nearest Landmark: N/A
Correspondence Address Details
Address: Sabarhad Beraicha State: Uttar Pradesh
Bojhi Bazar Po- Sub-Division/Station/ Ghosi Tahsil
Bojhi Division(Railways):
District/Region/Zone: Mau Pin Code: 275301
Village: Amila
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 8610081626 Email-ID: N/A
Contact Person: Shital Prasad Aadhaar No: 29XXXXXXXX62
Other Details
In case of New business – intended date of start: 25-01-2025
Source of Water Supply: N/A
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 14 - Beverages, excluding dairy products
2 01 - Dairy products and analogues, excluding products of food category 2.0
3 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
4 15 - Ready-to-eat savouries
5 16 - Prepared Foods
6 18- Indian Sweets and Indian Snacks & Savouries products
Document(s) Details
S.No. Documents Description Uploaded Document
1 Photo View
2 Identity Proof - Aadhar Card View
Other Document(s) Details
S.No. Documents Description Uploaded Document
1 Proof of Premises view
2 RECEIPT 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 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
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घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
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