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: 30250321119557017 Application Type: New Registration
Name of Applicant / PIZZA JUNCTION Application Date: 21-03-2025
Company: Kind of Business: Food Services - Food
Designation: Individual Vending Establishment
Address of Premises Where Food Business Is Located
Address: B.C. ROAD State: West Bengal
BARABAZAR
Sub-Division/Station/ BURDWAN-I
District/Region/Zone: PURBA Division(Railways):
BARDHAMAN Pan No: CKYPD5661E
Village: RAYAN-I Name: ATANU DUTTA
Pin Code: 713104 DOB: 05-08-1994
Nearest Landmark: N/A Gender: MALE
Correspondence Address Details
Address: B.C. ROAD State: West Bengal
BARABAZAR Sub-Division/Station/ BURDWAN-I
District/Region/Zone: PURBA Division(Railways):
BARDHAMAN Pin Code: 713104
Village: RAYAN-I
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 7980966361 Email-ID:
[email protected]Contact Person: ATANU DUTTA om
Aadhaar No: 68XXXXXXXX10
Other Details
In case of New business – intended date of start: N/A
Source of Water Supply: Private
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. No Name of the food category
1 07 - Bakery products
2 14 - Beverages, excluding dairy products
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
S.No. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 21-03-2025 195091451939928 pay_Q9Ua7vEdynhY7Q 100.00
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 : 21-03-2025 21:05:41 IST
Applicant Name : PIZZA JUNCTION
Page 2 of 3
Verified through Mobile : 79XXXXXX61
IP Address : 103.214.138.100
Page 3 of 3
