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Form "A"

[See Regula on 2.1.1 and Regula on 2.1.7

Application for Registration under Food Safety and Standards Act, 2006
Applica on No: 30180103183249210
Name of Applicant / Company : ANNAPOORANI MESS
All food processing units other than men oned above
Kind of Business : Permanent / Temporary Stall Holder
Manufacturer/Processor
Designa on : Individual

Address of Premises where food business is located Correspondence Address Details

Address : 9/10-7 HOUSING BOARD ROAD,KULATHUPALAYAM,KUNIAMUTHUR Address : 9/10-7 HOUSING BOARD ROAD,KULATHUPALAYAM,KUNIAMUTHUR
State : Tamil Nadu State : Tamil Nadu
District/Region/Zone : Coimbatore District/Region/Zone : Coimbatore
Sub-Division/Sta on Sub-Division/Sta on
/Division : Coimbatore Corpora on Ward-91 /Division : Coimbatore Corpora on Ward-91
(Railways) (Railways)
Village : Coimbatore Corpora on Ward-91 Village : Coimbatore Corpora on Ward-91
Pin Code : 641008 Pin Code : 641008

Contact Details

Tel No : NA Mobile No : 9003449812


Fax No : NA Email : shinenet2017@gmail.com
Contact Person : KALIMUTHU

Other Details
In case of New business – intended date of start : NA
In case of Sessional business, State the opening and closing period of the year : NA -NA
Source of Water Supply : Public
Sanc on Electricity Load or HP Used : NA
Upload Photo : 2018/1/RGPHID30180103183249210.jpg
Upload Document for Iden ty Proof
Aadhaar Card 2018/1/RGID30180103183249210.jpg
(eg: Ra on Card, Voter ID Card etc.)
Descrip on of the food items proposed to be manufactured or sold:
Sl. No. Name of the food category
1 16 - Prepared Foods

Submi ed Document(s):
Sl. No. Document Description Uploaded Document
1 Declara on Form 2018/1/30180103183249210_470_03012018063611.jpg

View Signed/Manually uploaded copy of


View
Form "A" :
Payment Details

Amount Rs. 100 Payment Mode TNINDUS

Challan
Transac on ID 6665313061 Transac on Date 09/01/2018 --
Number

Place :
____________________
Date : (Signature of the Applicant)