ADDITIONAL DETAILS REQUIRED FOR FSSAI REGISTRAT

SL. NO. DETAILS REQUIRED

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

3
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
6
District
Sub Division/Station/Muncipality/Notified Area
Ward No./Village
Pin Code
Mobile
Contact Landline if any
7
Details Contact Person
Email ID

Description of Food items proposed to be manufactured

8
or sold (AS PER ANNEXURE) only use number

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

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

Source of water supply (Private/ Public/ Government or

11
others ____________________) (if no than (N/A)
 If electricity used for business purposed (HP used in
12
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

ANNEXURE
S REQUIRED FOR FSSAI REGISTRATION
 Note :
mandatory, also provide the below mentioned document's

Pan Card
Aadhaar Card
Photo
Business Premises Proof