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ADDITIONAL DETAILS REQUIRED FOR FSSAI REGISTRATION ANNEXURE

SL. NO. DETAILS REQUIRED

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VALIDITY REQUIRED (IN YEAR) 1/2/3/4/5 1 Diary Products and analogues, excluding products of food category

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Name of the Applicant 2 Fats and oils and fats emulsions

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Name of the Firm/Company 3 Edible ices, including sherpet and sorbet

Kind of Business (Manufacture/ Retailer/ Distributor/


Wholeseller/Food Vending Agency/Home Based Canteen
4 Dhaba/ Supplier/Dhaba/Club
Canteen/Hotel/Restaurant/Transporter/Marketer/
Hawker(itinerant/mobile food vender), (Petty Retailer of
snacks/Tea Shops) 4 foods and vegetables

Designation
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(Individual / Partner / Proprietor /Director/Managing
Director/ others_________________)

Address of the Business Where Food Business is Located


State
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District
Sub Division/Station/Muncipality/Notified Area
Ward No./Village
Pin Code
Mobile
Contact Landline if any
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Details Contact Person
Email ID
Description of Food items proposed to be manufactured
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or sold (AS PER ANNEXURE) only use number

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


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

Source of water supply (Private/ Public/ Government or


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others ____________________) (if no than (N/A)

If electricity used for business purposed (HP used in


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number) like 100 HP/200 HP etc. (if no than (N/A)

13 Turnover if any (mandatory)

14 Business Within 1 State or MORE THAN 1 State

Note :
All the above in RED are mandatory, also provide the below mentioned document's

- Pan Card
- Aadhaar Card
- Photo
-Business Premises Proof

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