You are on page 1of 1

DECLARATION

I, Mr. DALARAM MOTIJI DEVASI S/o. Mr. MOTIJI DEVASI R/O. SHANKESHWAR APT.
ROOM NO 2 B WING GROUND FLOOR PADMA NAGAR ROAD NR BHARAT GREAIN STORE
SHRIRANGNAGAR BHIWANDI Thane do here by solemnly affirms and declares that all
information and particulars furnished here by me are true and correct to the best
of my knowledge. I further declare that the food business conducted or proposed
to be conducted by/through me conforms/shall conform to the Food Safety
and Standards Act, Regulation/ Bye-laws enacted thereunder, and specifically
to the Guidelines on Hygiene and Sanitary Practices provided under Schedule 4 of
the Registration and Licensing Regulation published by the Food Safety and
Standards Authority of India or any person authorized on its behalf from time to
time.

DATE: 28/12/2017

RAMESH DEPAR HARIA


SHOP NAME :
M/S. DALARAM MOTIJI DEVASI
ADDRESS & Contact No
SHANKESHWAR APT. ROOM NO 2 B WING GROUND FLOOR PADMA NAGAR ROAD NR
BHARAT GREAIN STORE SHRIRANGNAGAR BHIWANDI
CONT. 8605999848