Form C

Government of Uttar Pradesh

Department of Food Safety and Drug Administration
Food Safety and Standards Authority of India
License under FSS Act, 2006

अनुज्ञिप्त संख्या / License Number: 12723054000479

1. Name & Registered Office address of Satender Kumar S/o Babu Ram / Laxmi Dairy
Licensee / अनुज्ञिप्तधारी के पंजीकृत कायार्लय का नाम Moh. Bhoodwala 279 Near Walmiki Chowk
और पता: Bharana Road Bugrasi , Bulandshahar , Uttar
Pradesh-203403

2. Address of Authorized Premises / प्रािधकृत Moh. Bhoodwala 279 Near Walmiki Chowk
पिरसरो का पता: Bharana Road Bugrasi , Siana Tahsil,
Bulandshahar , Uttar Pradesh-203403

3. Kind of Business / कारोबार का प्रकार: Manufacturer - General Manufacturing

4. Dairy Business Details / डेयरी कारोबार िववरण हेतु : No

5. Category of License / अनुज्ञिप्त का वगर्: State License

This license is granted under and is subject to the provisions of FSS Act, 2006 all of which must be complied with by the
licensee. / यह अनुज्ञिप्त खाद्य संरक्षा और मानक अिधिनयम, 2006 के अधीन अनुदत्त की गई और वह अिधिनयम के उपबंधो के अध्यादीन है िजनका अनुज्ञिप्तधारी
द्वारा अवश्य पालन िकया जाना चािहए.

Place / स्थान: Bulandshahar Designated Officer

Issued On / िदनांक: 28-11-2023 (New License) Date : 28-11-2023 10:33:45
Valid Upto: / वैधता: 27-11-2024 (For details, refer Annexure) User Id : 109290
Verified through Mobile : 94XXXXXX92

License Grant on : 28-11-2023 10:32:24

License Issued On : 28-11-2023 10:33:45

Annexures:
1. Product Annexure
2. Validity Annexure
3. Non-Form C Annexure
4. Conditions Of License

Note:
1. Application for renewal of License can be filed as early as 180 days prior to expiry date of License.
You can file application for renewal or modification of License by login into FSSAI's Food Safety
Compliance System(https://foscos.fssai.gov.in) with your user id and password or call us at 1800112100
for any clarification.

2. This License is only to commence or carry on food businesses and not for any other purpose.

3. This is computer generated license and doesn't require any signature or stamp by authority.

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 Product Annexure

Form C
Government of Uttar Pradesh
Department of Food Safety and Drug Administration
Food Safety and Standards Authority of India
License under FSS Act, 2006

अनुज्ञिप्त संख्या / License Number: 12723054000479

Kind Of Business: Manufacturer - General Manufacturing

Production Capacity(MT / Day): .5

Sl.No. Food Category Sub-Food Category Product Kind of Business

1 02 - Fats and oils, and 02.1 - Fats and oils Vanaspati Manufacturer - General
fat emulsions essentially free from water [02.1.2] Manufacturing
2 02 - Fats and oils, and 02.1 - Fats and oils Ghee [02.1.1] Manufacturer - General
fat emulsions essentially free from water Manufacturing

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 Validation And Renewal Annexure

Form C
Government of Uttar Pradesh
Department of Food Safety and Drug Administration
Food Safety and Standards Authority of India
License under FSS Act, 2006

अनुज्ञिप्त संख्या / License Number: 12723054000479

Validity From Validity Upto Issued On Fee Paid Type Issuing

Authority
28-11-2023 27-11-2024 28-11-2023 3000 INR New State Licensing
Authority

Suspension History
S.No History Date
N/A

Current Status of License: License Issued

Note:
1. Application for renewal of License can be filed as early as 180 days prior to expiry date of License.
You can file application for renewal or modification of License by login into FSSAI's Food Safety
Compliance System(https://foscos.fssai.gov.in) with your user id and password or call us at 1800112100
for any clarification.

2. FSSAI vide order number 15(31)2020/FoSCoS/RCD/FSSAIpt1-Part(4) dated 11th January 2023 allowed
Instant Renewal of License / Registration.

3. FSSAI vide order number 15(31)2020/ FoSCoS/ RCD/ FSSAI dated 29th October 2021 has allowed the
renewal of Licenses / Registration till 180 days of the expiry date subject to payment of penalty.

4. Modification* (if any) denotes the change in the Authority. Issuing Authority mentioned along with
Modification* is the Jurisdictional Authority with effect from the date of issuance of modified
license.

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 Non-Form C Annexure

Government of Uttar Pradesh

Department of Food Safety and Drug Administration
Food Safety and Standards Authority of India
License under FSS Act, 2006

अनुज्ञिप्त संख्या / License Number: 12723054000479

Person in charge of operations

Name: Satender Kumar Qualification: Bsc

Contact No: N/A Mobile No: 9012155299
Email-ID: kumarsatender784@gmail.com
Address : Moh Bhoodwala Bugrasi
State: Uttar Pradesh District: Bulandshahar
Pin Code: 245403 Photo Id Card: Aadhar Card
Photo Id No: 495570093312 Photo Id Expiry Date: N/A
FoSTaC No: Not Provided
Person responsible for complying with conditions of license(The person must be same as mentioned
in Form IX, as per FSS Regulations, 2011)

Name: Satender Kumar Qualification: Bsc

Contact No: N/A Mobile No: 9012155299
Email-ID: kumarsatender784@gmail.com
Address : Moh Bhoodwala Bugrasi
State: Uttar Pradesh District: Bulandshahar
Pin Code: 245403 Photo Id Card: Aadhar Card
Photo Id No: 495570093312 Photo Id Expiry Date: N/A

Place / स्थान: Bulandshahar Designated Officer

Issued On / िदनांक: 28-11-2023 (New License) Date : 28-11-2023 10:33:45
User Id : 109290
Verified through Mobile : 94XXXXXX92

License Grant on : 28-11-2023 10:32:24

License Issued On : 28-11-2023 10:33:45

Note: Any change in above details shall be immediately communicated to authorities. You can apply
for modification of license for updation of details without any cost through Food Safety Compliance
System (https://foscos.fssai.gov.in)

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 Condition of License

All Food Business operators shall ensure that the following conditions are complied with at all times during
the course of its Food Business.

Food Business Operators Shall:

1. Display a true copy of the license granted in Form C shall at all time at a prominent place in the premises.

2. Give necessary access to licensing authorities or their authorized personnel to the premises.

3. Inform authorities about any change or modifications in activities.

4. Employ at least one technical person to supervise the production process. The person supervising the
production process shall possess at least a degree in science with Chemistry/ Bio- chemistry/ Food and
nutrition/ Microbiology or a degree or diploma in Food Technology/ Dairy Technology/ Dairy
Microbiology/ Dairy chemistry/ Dairy engineering/ Oil technology/ Veterinary science / Hotel
management & Catering technology or any degree or diploma in any other discipline related to the
specific requirement of the business from a recognized university or institute or equivalent.

5. Furnish periodic annual return 1st April to 31 st March, with in 31 st May of each year. For collection/
handling/manufacturing of milk and milk product half yearly return also to be furnished as specified.

6. Ensure that no product other than the product indicated in the license / registration is produced in the
unit.

7. Maintain factory's sanitary and hygienic standards and workers hygiene as specified in the schedule-4
according to the category of food business.

8. Maintain daily records of production, raw materials utilization and sales separately.

9. Ensure that the source and standards of raw material used are of optimum quality.

10. Food business operator shall not manufacture , store or expose for sale or permit the sale of any article of
food in any premises not effectively separated to the satisfaction of the licensing authority from any privy,
urine, sullage ,drain or place of storage of foul and waste matter

11. Ensure clean-in-place system (whatever necessary) for regular cleaning of machine & equipment.

12. Ensure testing of relevant chemical and/or microbiological contaminants in food products in accordance
with these regulation as frequency as required on the basis of historical data and risk assessment to
ensure production and delivery of safe food through own or NABLaccredited/ FSSAI recognized labs
atleast once in six month.

13. Ensure that as much as possible the required temperature shall be maintained throughout the supply
chain from the place of procurement or sourcing till it reaches the end consumer including chilling,
transportation, storage etc.

14. The Manufacturer/ Importer/ Distributer shall buy and sell food products only from, or to , licensed /
registered vendors and maintain record thereof.

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 Other Condition

1. Proprietors of hotels, restaurants and other food stalls who sell or expose for sale savouries, sweets or
other article of food shall put up a notice board containing separates lists of the articles which have been
cooked in ghee, edible oil, vanaspati and other fats for the information of the intending purchasers.

2. Food business operator selling cooked or prepared food shall display a notice board containing the nature
of articles being exposed for sale.

3. Every manufacture (including ghani operator) or wholesale dealer in butter ,ghee ,vanaspti ,edible oils,
solvent extracted oil, de oiled meal, edible flour and any other fats shall minimum a register showing the
quantity of manufactured, received or sold, nature of oil seed used and quantity of de oiled meal and edible
flour used etc. as applicable and the destination of each consignment of the substances sent out from his
factory or place of business, and shall present such register for inspection whenever required to do so by
the licensing authority.

4. No producer or manufacturer or vegetable oil ,edible oil and their products shall be edible for license under
this act ,unless he has own laboratory facility for analytical testing of samples

5. Every sale and movement of stocks of solvents- extracted oil ,'semi refined' or 'raw grade I' , edible
groundnut flour or edible coconut flour ,or both by the producer shall be a sale or movement of stocks
directly to a registered user and not to any other person ,and no such sale or movement shall be effected
through any third party.

6. Every quantity of solvent-extracted oil ,edible groundnut flour or edible coconut flour ,or both purchased by
a registered user shall be used by him in his own factory entirely for the purpose intended and shall not be
re-sold or otherwise transferred to any other person :
Provided that nothing in this sub-clause shall apply to the sale or movement of the following:-
1. Karanjia oil
2. Kusum oil
3. Mahua oil
4. Neem oil
5. Tamarind seed oil
6. Edible groundnut flour bearing the I.S.I certification mark
7. Edible coconut flour bearing the I.S.I certificate mark

7. No food business operator shall sell or distribute or offer for sale or dispatch or deliver to any person for
purpose of sale any edible oil which is not packed, marked and labeled in the manner specified in the
regulations unless specifically exempted from this condition vide notification in the official Gazette issued
in the public interest by food safety commissioners in specific circumstances and for a specific period and
for reason to be recorded in writing.

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