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ADDITIONAL DETAILS REQUIRED FOR FSSAI REGISTRA

SL. NO. DETAILS REQUIRED

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VALIDITY REQUIRED (IN YEAR) 1/2/3/4/5
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Name of the Applicant

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Name of the Firm/Company

Kind of Business (Manufacture/ Retailer/ Distributor/


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

5 Designation
(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
S REQUIRED FOR FSSAI REGISTRATION

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Note :
mandatory, also provide the below mentioned document's

Pan Card
Aadhaar Card
Photo
Business Premises Proof
ANNEXURE

Diary Products and analogues, excluding products of food category

Fats and oils and fats emulsions

Edible ices, including sherpet and sorbet

foods and vegetables

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