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: 30241228118602073 Application Type: New Registration
Name of Applicant / GYANTEERTH Application Date: N/A
Company: SHIKSHA EVAM Kind of Business: Trade/Retail - Retailer
KALYAN SANSTHA
TRUSTEE DHEERAJ
KUMAR BAHIRANI
Designation: Co-operative Society
Address of Premises Where Food Business Is Located
Address: 03 RAI SINGH KA State: Madhya Pradesh
BAGH SIKANDAR
Sub-Division/Station/ Gwalior (Gird)
KAMPOO LASHKAR
Division(Railways):
District/Region/Zone: Gwalior Pan No: ARRPB2578C
Village: Gird Name: DHEERAJ KUMAR
Pin Code: 474001 BAHRANI
Nearest Landmark: N/A DOB: 26-06-1990
Gender: MALE
Correspondence Address Details
Address: 03 RAI SINGH KA State: Madhya Pradesh
BAGH SIKANDAR Sub-Division/Station/ Gwalior (Gird)
KAMPOO LASHKAR Division(Railways):
District/Region/Zone: Gwalior Pin Code: 474001
Village: Gird
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9826537933 Email-ID: gyanteerthsiksha@gma
Contact Person: DHEERAJ KUMAR il.com
BAHRANI Aadhaar No: 48XXXXXXXX99
Other Details
In case of New business – intended date of start: 31-12-2024
Source of Water Supply: Public
Sanction Electricity Load or HP Used: No
Page 1 of 3
Number of years applied for: 5
Detail(s) of Food Item
[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 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
2 10 - Eggs and egg products
3 15 - Ready-to-eat savouries
4 101 - Hemp Seeds and Seed Products
5 18- Indian Sweets and Indian Snacks & Savouries products
6 11 - Sweeteners, including honey
7 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
8 03 - Edible ices, including sherbet and sorbe
9 01 - Dairy products and analogues, excluding products of food category 2.0
10 12 - Salts, spices, soups, sauces, salads and protein products
11 13 - Foodstuffs intended for particular nutritional uses
12 05 - Confectionery
13 02 - Fats and oils, and fat emulsions
Document(s) Details
S.No. Documents Description Uploaded Document
1 Identity Proof - Pan Card View
2 Photo View
Other Document(s) Details
S.No. Documents Description Uploaded Document
1 Proof of Premises view
2 declaration view
3 SOCIEETY CERTIFICATE 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.
Page 2 of 3
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
Page 3 of 3
