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: bhanupratap.sing17@bimtech.ac.in

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

7@bimtech.ac.in

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.