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: 30220823111415192 Application Type: Renewal
Name of Applicant / OM CHAITNYA Application Date: 23-08-2022
Company: VIRBHADRA KIRANA Kind of Business: Trade/Retail - Retailer,
AND HOTEL PROP:- Food Services - Hotel,
SAU SAVITA POPAT Other(s) - Digital
KHEMNER banking and financial
Designation: Individual services
Expiry Date: 24-04-2022 Certificate No: 21517180000075
Address of Premises Where Food Business Is Located
Address: GRM NO 1037 State: Maharashtra
MANDVE BK,TAL-
Sub-Division/Station/ Jamkhed
SANGAMNER
Division(Railways):
District/Region/Zone: Ahmadnagar Pin Code: 422622
Village: Loni
Nearest Landmark: MANDAVE BK
Correspondence Address Details
Address: GRM NO 1037 State: Maharashtra
MANDVE BK,TAL- Sub-Division/Station/ Sangamner
SANGAMNER Division(Railways):
District/Region/Zone: Ahmadnagar Pin Code: 422622
Village: Mandave Bk.
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9860144015 Email-ID:
[email protected]Contact Person: SAVITA POPAT om
KHEMNER
Other Details
In case of New business – intended date of start: N/A
Source of Water Supply: N/A
Sanction Electricity Load or HP Used: No
Number of years applied for: 5
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Detail(s) of Food Item
[Note:Only standardised food products are allowed to be manufactured as per the list available on FoSCoS.]
Other then Manufacturer Unit
Sl. No Name of the food category
1 15 - Ready-to-eat savouries
2 99 - Substances added to food
Document(s) Details
S.No. Documents Description Uploaded Document
1 Any Other Document View
2 Declaration Form View
3 Health NOC View
4 Identity Proof - Aadhar Card View
5 NOC by Municipality/Panchayat View
6 Photo - Aadhar Card View
Other Document(s) Details
S.No. Documents Description Uploaded Document
1 NOC by Municipality/Panchayat view
Payment Details
S.No. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 23-08-2022 9117474146446332 pay_K95JxwNi1ctGzv 1000.00
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 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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