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: 30250711120695370 Application Type: New Registration
Name of Applicant / Indresh kumar Application Date: 11-07-2025
Company: Kind of Business: Food Services - Club/
Designation: Individual Canteen
Address of Premises Where Food Business Is Located
Address: ML Convent 235P State: Uttar Pradesh
Karaelabagh
Sub-Division/Station/ Nagar Nigam Food
District/Region/Zone: Prayagraj Division(Railways): Safety Zone-03
Village: Karelabagh Pan No: GATPK9667J
Pin Code: 211001 Name: INDRESH KUMAR
Nearest Landmark: ML CONVENT DOB: 01-01-1985
Gender: MALE
Correspondence Address Details
Address: ML Convent 235P State: Uttar Pradesh
Karaelabagh Sub-Division/Station/ Nagar Nigam Food
District/Region/Zone: Prayagraj Division(Railways): Safety Zone-03
Village: Karelabagh Pin Code: 211001
Contact Details
Telephone No: 8382988440 Fax: N/A
Mobile No: 8382988440 Email-ID: indreshshukla071983@
Contact Person: INDRESH SHUKLA gmail.com
Aadhaar No: 39XXXXXXXX99
Other Details
In case of New business – intended date of start: 11-07-2025
Source of Water Supply: Other - school
Sanction Electricity Load or HP Used: No
Number of years applied for: 2
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 than Manufacturer Unit
Sl. No Name of the food category
1 16 - Prepared Foods
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 addhar card view
S.No. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 11-07-2025 4105769699601873 pay_QrdJhkqDg0di7E 200.00
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.
Declaration || Condition of License || Inspection Checklist
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
Date & Time : 11-07-2025 10:14:37 IST
Applicant Name : Indresh kumar
Verified through Mobile : 83XXXXXX40
IP Address : 106.205.184.102
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