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: 30230211112734442 Application Type: New Registration
Name of Applicant / AK Organics Application Date: 11-02-2023
Company: Kind of Business: Trade/Retail - Retailer
Designation: Individual
Address of Premises Where Food Business Is Located
Address: Plot no. 2339,Tahal State: Bihar
Tola,Dhanaut,Phulw
Sub-Division/Station/ Danapur
ari sarif,
Division(Railways):
District/Region/Zone: Patna Pin Code: 801506
Village: Dhanaut
Nearest Landmark: N/A
Correspondence Address Details
Address: Plot no. 2339,Tahal State: Bihar
Tola,Dhanaut,Phulw Sub-Division/Station/ Danapur
ari sarif, Division(Railways):
District/Region/Zone: Patna Pin Code: 801506
Village: Dhanaut
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9798819649 Email-ID: N/A
Contact Person: Kaushal kumar
Other Details
In case of New business – intended date of start: 11-02-2023
Source of Water Supply: Private
Sanction Electricity Load or HP Used: No
Number of years applied for: 1
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 then Manufacturer Unit
Sl. Name of the food category
No
1 01 - Dairy products and analogues, excluding products of food category 2.0
2 02 - Fats and oils, and fat emulsions
3 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
4 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
5 05 - Confectionery
6 12 - Salts, spices, soups, sauces, salads and protein products
Document(s) Details
S.No. Documents Description Uploaded Document
1 Identity Proof - Aadhar Card View
2 Photo - Aadhar Card View
Other Document(s) Details
S.No. Documents Description Uploaded Document
1 Proof of Premises view
2 Proprietor details view
3 PAN No. view
4 Self Declaration by Proprietor view
5 product pic1 view
6 Exemption request Jaivik India Small Intermediary view
7 Photo of business premises -1 view
8 Landlord NOC to use premise view
9 photo of buisiness premises2 view
10 Certificate of Organic producer - Rohtas Organic view
S.No. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 11-02-2023 7737931077043634 pay_LF2rFJ0mdkSA3C 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.
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I have read/understood the punishment provision under Section 61 of FOOD SAFETY AND STANDARDS ACT,
2006."61. Punishment 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 punishable with imprisonment for a term which may extend to three months and also with fine
which may extend to two 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 : 26-03-2023 19:38:45 IST
Applicant Name : AK Organics
Verified through Mobile : 97XXXXXX49
IP Address :
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