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: 30250618120430668 Application Type: Modification
Name of Applicant / SHRI SAI RAJ Application Date: N/A
Company: ENTERPRISE Kind of Business: Food Services - Hawker
Designation: Individual (Itinerant / Mobile
Expiry Date: 15-02-2030 food vendor)
Certificate No: 22724922000143
Address of Premises Where Food Business Is Located
Address: Pink vending zone State: Uttar Pradesh
Fortis hospital
Sub-Division/Station/ NOIDA CITY ZONE-1
gate no 3 & 4 plot
Division(Railways):
no. B 22, sector 62
Noida Pan No: N/A
District/Region/Zone: Gautam Buddha
Nagar
Village: SECTOR-62 NOIDA
Pin Code: 201301
Nearest Landmark: N/A
Correspondence Address Details
Address: Pink vending zone State: Uttar Pradesh
Fortis hospital Sub-Division/Station/ NOIDA CITY ZONE-1
gate no 3 & 4 plot Division(Railways):
no. B 22, sector 62
Pin Code: 201301
Noida
District/Region/Zone: Gautam Buddha
Nagar
Village: SECTOR-62 NOIDA
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9654177613 Email-ID: N/A
Contact Person: aparna sharma
Other Details
In case of New business – intended date of start: N/A
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Source of Water Supply: Public
Sanction Electricity Load or HP Used: No
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 14 - Beverages, excluding dairy products
2 12 - Salts, spices, soups, sauces, salads and protein products
3 15 - Ready-to-eat savouries
4 16 - Prepared Foods
5 05 - Confectionery
6 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
7 07 - Bakery products
8 10 - Eggs and egg products
9 99 - Substances added to food
10 13 - Foodstuffs intended for particular nutritional uses
Document(s) Details
S.No. Documents Description Uploaded Document
1 Photo View
2 Identity Proof - 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. Penalty for false information. If a person, in connection with a requirement or direction under this
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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
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