ADDITIONAL DETAILS REQUIRED FOR FSSAI REGISTRA

SL. NO. DETAILS REQUIRED

1
Name of the Applicant

2
Name of the Firm/Company

Kind of Business (Manufacture/ Retailer/ Distributor/

2 Hole seller/Food Vending
Agency/Supplier/Caterer/Dhaba/Club
Canteen/Hotel/Restaurant/Transporter/Marketer/
Hawker(itinerant/mobile food vender), (Petty Retailer of
snacks/Tea Shops) etc.

3 Designation
(Individual / Partner / Proprietor / others)

Address of the Business Where Food Business is Located

State
4
District
Sub Division/Station/Muncipality/Notified Area
Ward No./Village
Pincode
Mobile
Contact Landline if any
5 Details Contact Person
Email ID
6 Correspondance Address if any

Description of Food items proposed to be manufactured

7 or sold

In case of new Business (intend Date of start) if no than

8 (N/A)
In Case of sessional business (State opening and closing
9 date) if no than (N/A)

10 Source of water supply (if no than (N/A)

If electricity used for business purposed (State Load or

11 HP used)

12 Turnover if any

13 Business Within 1 State or MORE THAN 1 State

14 Date of Start of Business

(It should not be a Future Date)
Note :
1 All the above in RED are mandatory, pls provide every detail asked above.
2 Along with furnishing all the above mentioned details, also sign the declaration form attached & mail
us a scan copy of the declaration.
3 Also send following Documents
- Pan Card
- Aadhaar Card
- Photo
S REQUIRED FOR FSSAI REGISTRATION
de every detail asked above.
d details, also sign the declaration form attached & mail