9/23/2014 FSSAI Licensing & Registration System

http://foodlicensing.fssai.gov.in/SLS/FBO/SL_DocumentsNewLicense.aspx?ReqID=56886111 1/2
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Form "B"
[See Regulation 2.1.2, Regulation 2.1.3 and Regulation 2.1.7]
Application for License / Renewal of license under Food Safety and Standards Act, 2006
Business Details
Company Name Shri Venkatesa Milk Center Premises Address
S.F 538/1, Door 157,
Govindhapuram Village & Post,
Dharapuram Tk, Tiruppur Dt - 638 657.

Kind of Business License Category Eligiblity
Manufacturer - Dairy units including milk chilling units equipped to
handle or process
State License More than 500 ltrs milk upto 50,000 litres/day
S.No. Document Description Submission Type Upload Document(s)/Remark(s)
1
Blueprint/layout plan of the processing unit showing the dimensions in
metres/square metres and operation-wise area allocation (mandatory for
manufacturing and processing units only)
Electronically
Physically
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2
List of Directors/Partners/Proprietor/Executive Members of Society/Trust with
full address and contact details (mandatory for companies only)
Electronically
Physically
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3
Name and List of Equipments and Machinery along with the number, installed
capacity and horse power used (mandatory for manufacturing and processing
units only)
Electronically
Physically
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4
Photo I.D and address proof issued by Government authority of
Proprietor/Partner/Director(s)/Authorised Signatory. (optional)
Electronically
Physically
Not Applicable
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5 List of food category desired to be manufactured. (In case of manufacturers)
Electronically
Physically
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6
Authority letter with name and address of responsible person nominated by
the manufacturer along with alternative responsible person indicating the
powers vested with them viz assisting the officers in inspections, collection of
samples, packing & dispatch. (for manufacturers / processors)
Electronically
Physically
Not Applicable
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7
Analysis report (Chemical & Bacteriological) of water to be used as ingredient
in food from a recognized/ public health laboratory to confirm the portability
(mandatory only for manufacturing and processing units only)
Electronically
Physically
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8
Proof of possession of premises. (Sale deed/ Rent agreement/ Electricity bill,
etc.) (optional)
Electronically
Physically
Not Applicable
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9
Partnership Deed/Affidavit of Proprietorship/Memorandum & Articles of
Association towards the constitution of the firm. (optional)
Electronically
Physically
Not Applicable
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10
Copy of certificate obtained under Coop Act - 1861/Multi State Coop Act -
2002 in case of Cooperatives. (wherever applicable)
Electronically
Physically
Not Applicable
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11 NOC from manufacturer (mandatory for relabellers and repackers only)
Electronically
Physically
Not Applicable
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12 Food Safety Management System plan or certificate (if any)
Electronically
Physically
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13
Source of milk or procurement plan for milk including location of milk
collection centres etc. in case of Milk and Milk Products processing units.
(wherever applicable)
Electronically
Physically
Not Applicable
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14
Source of raw material for meat and meat processing plants. (wherever
applicable)
Electronically
Physically
Not Applicable
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15
Pesticide residues report of water in case of units manufacturing packaged
drinking water, packaged Mineral water and/or carbonated water from a
recognised/ public health laboratory
Electronically
Physically
Not Applicable
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16
Recall plan wherever applicable, with details on whom the product is
distributed. (optional)
Electronically
Physically
Not Applicable
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17 NOCs from Municipality or local body. (optional)
Electronically
Physically
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9/23/2014 FSSAI Licensing & Registration System
http://foodlicensing.fssai.gov.in/SLS/FBO/SL_DocumentsNewLicense.aspx?ReqID=56886111 2/2
Not Applicable
Upload
18 Form IX: Nomination of Persons by a Company Click here to Download
Electronically
Physically
Not Applicable
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19 Board Resolution with respect of Nominee
Electronically
Physically
Not Applicable
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Note: The period cannot be changed once the application has been submitted.
Period for which license required (1 - 5)* Select Year Years
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