FSSAI Licensing and Registration Self Declarations

Self Declarations for Food Safety and Standards Authority of India

Food business owners may apply for a license under the FSS (Licensing and Registration) Regulations by submitting a "Undertaking by way of Self Declaration instead of Affidavits."

Along with the application for licencing and registration, the following forms will be sent in plain paper. 

The three new FORMS that need to be filled out for various purposes are as follows:

Declaration regarding Food Safety Management System (FSMS)

(To be given on the Letterhead of the FBO/Firm/Company)

I/We ,………………………… as [Proprietor/ Partner/ Director/ Authorised Signatory of M/S],

located at……………………. of………………………… (Name of the State/UT), hereby declare that:

1. I am/ We are an applicant for new  license/  conversion  of  existing  license/ modification of existing license/ renewal of existing license under the Food Safety and Standards Act (FSS Act),  2006.
2. The nature of business of my/our firm is (fill in whatever is applicable):

(a) Manufacturer/Repacker of …………………….  (Name    of    product(s)…………………….                    (as mentioned in the product description of the online Form B)…………………………..

(b) Importer of food products allowed under the FSS Act, 2006 and the Rules and Regulations there under;

(c) Storage/Retail/Hotel/Restaurant of ………………….. (Name of the broad categories as mentioned in the product description of the online Form B)       ……………………………….

3. I/ We have a food safety plan to ensure that the articles of food, as mentioned above, satisfy the requirements of the FSS Act, 2006 and the Rules and Regulations there under.
4. I/ We further undertake that I/ We shall put in place a Food Safety Management System (FSMS) and get the same certified from an Accredited Agency as soon as the Accredited agencies are notified by the Food Authority;
5. Our facility shall comply with the general hygiene and sanitary requirements as mentioned in the Schedule 4 of the Food Safety and Standards (Licensing and Registration of Food business) Regulations, 2011.

Signatures   of   the   Authorised        Signatory with Stamp/ Seal

Name:
Place:
Address:
Date:
Contact Nos:

Self – Declaration for Proprietorship

(To be given on the Letterhead of the FBO/Firm/Company)

I, ……………………………..  S/o/D/o/W/o …………………………R/o  ……………………,                            do hereby state and affirm as follows:-

1. I am the sole owner/ proprietor of a business operating under the name and style …………… “operating from………………………………. (address of the premise)…………………………….
2. This business is not undertaken/ operated by a partnership firm or limited liability company.
3. It is also to declare that below mentioned person is my legal nominee for the said proprietorship concern………………………………………..

Relationship with the proprietor……………………………………….

4. That the contents of this declaration are true and correct to the best of my knowledge and belief.

Signatures of the proprietor with Stamp/ Seal

Name:

Place:

Address:

Date:

Contact Nos:

New Undertakings

Undertaking from FBOs who are repacking food products including agricultural commodities like rice, pulses, fruits and vegetables etc. and procuring raw material from different manufacturers, licensed food vendors and local mandis

Declaration and Undertaking by Food Business Operator
(For Repacker/Repackagers)

(To be given on the Letterhead of the FBO/Firm/Company)

I/We…………………………..[as Proprietor/ Partner/ Director/ Authorised Signatory of M/S……………………….. located at …………………….    (Place of location) ……………. in……………..   (name of the State/UT), hereby declare and undertake that:

1. I am/We are an applicant for new license/ modification of existing license under the Food Safety and Standards Act (FSS Act), 2006.
2. The nature of business of my /our Firm/ Company is Re-packaging of……………………….

(Name of product(s) as mentioned in the product description of the online Form B)…………………..

3. The above food items shall be purchased /procured only from vendors having valid license/ registration under the FSS Act, 2006 and repacked in our repackaging unit aforementioned.
4. The above mentioned food items shall be brought/ transported to our u nit under hygienic conditions with proper bulk packaging while maintaining the special storage/ transport conditions.

I/ We shall comply with the general hygiene and sanitary requirements as mentioned in Schedule 4 of the Food Safety and Standards (Licensing and Registration of Food business) Regulations, 2011, at all times and shall be responsible and liable for any violation thereof.

Signatures of the Authorised Signatory with Stamp/ Seal

Name:
Place:
Address:
Date:
Contact Nos:

All the Self Declaration can be downloaded from here