Food Safety and Standards Authority of India Ministry of Health ...

FORM- A
APPLICATION FOR GRANT/RENEWEL OF LICENCE UNDER FOOD SAFETY AND STANDARDS
(LICENSING REGULATIONS)
To,
PHOTO
The Licensing Authority
…………….
………………..
Madam/Sir,
I hereby apply for grant/ renewal of Licence as per details given below:
1. Name of Applicant (in block letters) ____________________________________
2. Father’s/Husband’s/ Wife’s name ______________________________________
3. Age ______________________________________________________________
4. Residential address (Present) __________________________________________
__________________________________________________________________
(xv) Permanent _____________________________________________________
__________________________________________________________________
5. (i) Name & address of the Establishment ________________________________
for which licence is required ________________________________________
__________________________________________________________________
______
(ii) Whether the establishment is proprietorship/ __________________________
partnership/society/company etc. ___________________________________
(iii) If licence is required for godown/workshop, address ___________________
of premises where food articles are to be sold. _________________________
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