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: 30250730120939368 Application Type: New Registration
Name of Applicant / SOURABH ANIL Application Date: N/A
Company: KOTKAR / KORA Kind of Business: Trade/Retail - Retailer
MEDLIFE
Designation: Proprieter
Address of Premises Where Food Business Is Located
Address: SHOP NUMBER B State: Maharashtra
22 GROUND
Sub-Division/Station/ Haveli
FLOOR MOUNT
Division(Railways):
BRISA KAMTHE
NAGAR Pan No: N/A
YEVALEWADI PUNE
District/Region/Zone: Pune
Village: Yewalewadi
Pin Code: 411048
Nearest Landmark: N/A
Correspondence Address Details
Address: SHOP NUMBER B State: Maharashtra
22 GROUND Sub-Division/Station/ Haveli
FLOOR MOUNT Division(Railways):
BRISA KAMTHE
Pin Code: 411048
NAGAR
YEVALEWADI PUNE
District/Region/Zone: Pune
Village: Yewalewadi
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9960761261 Email-ID: kora.medlife@gmail.c
Contact Person: SOURABH ANIL om
KOTKAR Aadhaar No: 89XXXXXXXX91
Other Details
In case of New business – intended date of start: 30-07-2025
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Source of Water Supply: Private
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. No Name of the food category
1 13 - Foodstuffs intended for particular nutritional uses
Document(s) Details
S.No. Documents Description Uploaded Document
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
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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