Declaration for business slab under 12 lakhs per annum, Application for Registration

I Mr./Mrs./Ms. S/o D/o, W/o Mr

on behalf of , resident of do
hereby solemnly affirm and declare that:

1. Expected annual turnover of food business is under INR 12 lakhs, hence applying for FSSAI
Registration.
2. I /we will apply for License as soon as annual turnover of food business exceeds INR 12 lakhs.

I do hereby solemnly affirm and declare that and declare that all information and particulars furnished
here by me /us, are true and correct to the best of my/our knowledge.

Date:
Place:

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