LAXMI CHEMIST

Plot No. 10, Gopal Nagar Main Road, Gopal nagar, Pallikaranai,
Chennai, Tamil Nadu, 600100
Email Id: - laxmichemistchn@gmail.com

Declaration regarding Food Safety Management System (FSMS)

We Sachin vitthal Fanse and Santosh Kishor Swami as Partners of M/s Laxmi Chemist, located at Plot no
10,Gopal nagar main road, Gopal nagar,Pallikaranai-600100 of Tamil Nadu hereby declare that,

1. We are an applicant for new license under the Food Safety and Standards Act (FSS Act), 2006.

2. The name of business of our firm is Laxmi chemist

Storage/Distributer of Cereals and cereal products, derived from cereal grains, from
roots and tubers, pulses, legumes and pith or so core of palm tree, excluding bakery wares of
food category 7.0 and Salts, spices, soups, sauces, salads and protein products

3. I have a food safety plan to ensure that the articles of food, as mentioned above, satisfy the
requirements of FSS Act, 2006 and the Rules and Regulations there under.

4. I further undertake that I shall put in place a Food Safety Management System (FSMS) and get
the same certified from an Accredited Agency as soon as the Accredited Agencies are notified by
the Food Safety;

5. Our facility shall comply with the general hygiene and sanitary requirements as mentioned in
the Schedule 4 of the Food Safety and Standards (Licensing and Registration of Food business)
Regulations, 2011.

Signatures of Authorized Signatory

Name: Sachin Vitthal Fanse

Name:Santosh Kishor Swami

Place: Chennai Address: Plot no 10,Gopal nagar main road,

Gopal nagar,Pallikaranai-600100

Date :05/09/2019 Contact No : 8807163300

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 LAXMI CHEMIST
Plot No. 10, Gopal Nagar Main Road, Gopal nagar, Pallikaranai,
Chennai, Tamil Nadu, 600100
Email Id: - laxmichemistchn@gmail.com