AFFIDAVIT

This Affidavit Is Made Before Execute Magistrate In Shriwardhan.

I Mr MOHAMED ALI KHALIL KAZI age about 65 years and residing at walavati taluka
shriwardhan,district raigad, do hereby solemnly affirm and declare as follows.

I am sole proprietor/partner/director of ROYAL GENERAL STORE AND ICE CREAM its

office/carry on business/registered office at Walwati taluka shriwardhan district raigad.

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1. I wish to apply for registration under food safety and standards act, 2006 and
rules 2011 as a RETAIL BUSINESS as my annual turnover from the food
business is not exceeding Rs.12 lakhs.
2. As soon as annual turnover of my establishment firm/company or …………….etc.
from the food business exceeds 12 lakh, I will intimate to registering authority
and also approach to appropriate authority for license immediately.
3. The pan number of firm/company is ……………………….
4. I know that, this is merely a registration certificate and not a license and thus not
by itself right of legal ownership on structure/land etc. Or confer any right of the
ownership on the date and time of existence of the structure in which my food
establishment is located.

Signature of deponent/deponents

Verification

Verified and signed at shriwardhan on 11/03/2019 that the contents of above par
as are true and correct to best of my knowledge and belief. If the above
information is/or the information given by me in my application for registration
dated in found to be false, I shall be liable for legal action in accordance law.

Signature of deponent/deponents