Registration Details https://foodlicensing.fssai.gov.in/REG/RG_ViewDetails.aspx?ReqID=3...

Form "A"
[See Regula on 2.1.1 and Regula on 2.1.7

Application for Registration under Food Safety and Standards Act, 2006
Applica on No: 30190711202335500
Name of Applicant / Company : MOHAMMAD IQBAL
All food processing units other than men oned above
Manufacturer/Processor
Kind of Business :
Food stalls/arrangements in Religious gatherings, fairs etc
Food Vending Agencies
Designa on : Individual

Address of Premises where food business is located Correspondence Address Details

5-121,PUTTHIGE PADAVU POST, SAMPIGE, PUTTHIGE, 5-121,PUTTHIGE PADAVU POST, SAMPIGE, PUTTHIGE,
Address : Address :
MANGALORE TALUK, DAKSHINA KANNADA MANGALORE TALUK, DAKSHINA KANNADA
State : Karnataka State : Karnataka
District/Region/Zone : Dakshina Kannada District/Region/Zone : Dakshina Kannada
Sub-Division/Sta on Sub-Division/Sta on
/Division : Mangalore /Division : Mangalore
(Railways) (Railways)
Village : Puthige Village : Puthige
Pin Code : 574227 Pin Code : 574227

Contact Details

Tel No : NA Mobile No : 9980075278

Fax No : NA Email : MYHMDB@gmail.com
Contact Person : NA

Other Details
In case of New business – intended date of start : 11/07/2019
In case of Sessional business, State the opening and closing period of the year : NA -NA
Source of Water Supply : Public

Sanc on Electricity Load or HP Used : NA

Upload Photo : 2019/7/RGPHID30190711202335500.jpg

Upload Document for Iden ty Proof
Aadhaar Card 2019/7/RGID30190711202335500.pdf
(eg: Ra on Card, Voter ID Card etc.)

Descrip on of the food items proposed to be manufactured or sold:

Sl. No. Name of the food category
1 07 - Bakery products
2 16 - Prepared Foods

Submi ed Document(s):
Sl. No. Document Description Uploaded Document
1 Declara on Form 2019/7/30190711202335500_4269_11072019083808.pdf

Place :
____________________
Date : (Signature of the Applicant)

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