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DIN
TAN
TIN
FORM B(FOOD LICENSE)
Form ‘B’
[See Regulation 2.1.2, Regulation 2.1.3 and Regulation2.1.7]
Application for License / Renewal of license except importing under Food Safety and Standards
Act, 2006
Kind of business (Please tick more than one, if applicable):
Manufacturing/Processing including sorting, grading etc. Milk Collection/chilling
Slaughter House
Solvent extracting unit
Solvent extracting plant equipped with pre cleaning of oil seeds or pre expelling of oil.
Solvent extracting and oil refining plant. Packaging
Relabeling (manufactured by third party under own packing and labeling)
Importing
Storage/Warehouse/Cold Storage
Retail Trade
Wholesale Trade
Distributor/Supplier
Transporter of food
Catering
Dhabha or any other food vending establishment
Club /canteen
Hotel
Restaurant
Other(s), please specify:_____________________
1. Name of the Company/Organization: ____________comics_________________________________
2. Registered Office Address:
_______T-04/43 Builders Avenue Vasant Kunj, Delhi____________
3. Address of Premise for which license is being applied
T-2/1 Teg Bahadur Shopping Complex, Vasant Kunj
4. Name and/or designation, qualification and address of technically qualified person in charge
of operations as required under Regulation Name:
Qualification: PGDM
Address: 4S 1003 AWHO FLATS GURJINDER VIHAR SEC CHI-II, GREATER NOIDA 201301
Telephone Number(s):
Mobile no: 9599381906
Email: [email protected]
Photo Identity card no and expiry date
5. Name and/or designation, address and contact details of person responsible for complying
with conditions of license (if different from 4 Above):
Name: Bhanu
Address: : 4S 1003 AWHO FLATS GURJINDER VIHAR SEC CHI-II, GREATER NOIDA 201301
Telephone Number(s):
Mobile no
9599381906
Email:
bhanupratap.singh1
Photo Identity card no and expiry date
6. Correspondence address (if different from 3 above) ________________________________________________________________
______________________________________________________________
7. TelNo.:____________Mobile No.:______________
Fax No:_______________ Email:___________________
8. Food items proposed to be manufactured:
S.No. Name of Food
category/item
Quantity in Kg per day or M.T. per annum
If required attach separate sheet
If already having valid license- mention annual quantity of each food category manufactured during
last three years
9. Installed Capacity food product wise (per
day)____100 Kg___________________________
10. For Dairy units
(i) Location and installed capacity of Milk Chilling Centers (MCC) / Bulk Milk Cooling Centers (BMCs)/ Milk Processing Unit/ Milk Packaging Unit in litres owned or managed by the applicant.
S.No. Name and address of MCC/BMC Installed Capacity
If required attach separate sheet
(i) Average Quantity of milk per day to be used/handled in
a. in lean season___________________________
b. in flush season__________________________ (iii) Milk products to be manufactured and their manufacturing capacity
(tones/year)
1)………………
2)………………
3)………………
11. For Solvent –Extracted Oil, De oiled meal and Edible Flour:
(i) Details of proposed business
Name of
Oil bearing material
From seed or nut or cake
Solvent –Extracted Oil, De oiled meal and Edible Flour Vegetable
Oil
Crude Neutralized Neutralized
& Bleached
Refined De oiled meal
Edible
Flour
If already having valid license- mention annual quantity of each product manufactured during last
three years
ii) Name and address of factory or factories used by the miller or solvent extractor for processing oil
bearing material produced or procured by him or for refining solvent extracted Oil produced by him.
________________________________________________________________ __________
________________________________________________________________
__________
12. Sanctioned electricity load or HP to be used -
_________________________________
13. Whether unit is equipped with an analytical laboratory
_________________________________
If yes the details thereof:-
________________________________________________________________
14. In case of renewal or transfer of license granted under other laws as per proviso to
Regulation 5(1) - period for which license required ( 1 to 5 years)
15. I/We have forwarded a sum of Rs.___________ towards License fees according to the
provision of the Food Safety and Standards Regulations, 2011 vide:
Demand Draft no (payable to ……………….)
(Signature of the applicant/authorized signatory)
EATING LICENSEAPPLICATION FOR THE GRANT OF REGISTRATION CERTIFICATE OF EATING HOUSE
I hereby apply for the grant of a Registration Certificate of an eating house under Delhi Eating Houses Registration Regulations and the required information is furnished below :-
1. Name of the Eating House : ………………………………………COMICS…………………………………
2 Complete address of the Eating House : ………T 2/1…TEG BAHADUR COMPLEX…VASANT KUNJ DELHI…………..
with the name of P.S. & Phone No. along with two postcard size photographs of the place showing its usage as an Eating House.
3. Full name and parentage of the applicant : ………Bhanu Pratap Singh…………………..
4. Complete residential address of the : 4S-1003 AWHO FLATS GURJINDER VIHAR GREATER NOIDA.
Applicant with name of P.S. &
Mobile/Phone No. with
documentary proof like Election Card,
Driving Licence & Passport etc.
5. Whether applicant is owner/Tenant : …………TENZNT…………………………………………
(Document(s) to prove the legal occupancy of the Place of Eating House and in case of
tenancy, NOC from land lord in the form of affidavit on stamp paper of Rs.10/- duly attested.)
6. Municipal Trade License with its validity : ………JULY
2019……………………………………………………………. (attach photocopy of TL with fee receipt)
7 No. of the Registration Certificate under : …………………xxxxxxxx………………………………………………………
the Shops & Establishment Act
8 Whether the applicant applied for a :…………………………………NO………………………………………………. R.C. earlier. If yes, when and with what result.
9. Seating Capacity : ………………………………………………40………………………………
(Attach Fire NOC, if Seating Capacity
is 50 or more) 10 . Attach Site plan containing details : ………………………………………………………………….
of the size of the Eating House 11. Details of proposed/existing facilities like ........................…………………………………….
Music & live performances, dance floor, Bars & disco etc. and in case of no such facilities, an undertaking to this effect be Attached.
1 2. Affidavit on prescribed format on stamp : ……………………………………………….
paper of Rs. 10/- along with its supporting documents.
SIGNATURE OF THE APPLICANT
DATED :………10.01.17………………………….
Note: - 1. Incomplete application is liable to rejected straight way. 2. All the Photostat copies of the documents submitted shall be self attested.