Schedule- 14(58)
(Relating to Sub-rules (3) and (5) of Rule 28)
License for Food Industry
Serial No. Ref. No. and Dispatch No.:
1. Name of shop or firm:
2. Address:
3. Entrepreneur’s name and surname:
4. Name and surname of the person taking responsibility for the activities of
industry:
5. Father’s name:
6. Grand-father’s name:
7. Birth place:
8. Permanent address (including Ward No.):
9. Temporary address (including Ward No.):
10. Name of the food intended to be produced or sold or distributed:
11. Signature:
12. Thumb impressions (only when one cannot sign)59: Right
12. Thumb impressions (only when one cannot sign)
59: Right Left
13. Photograph:
Signature of the licensing authority60:
Signature and the office seal falling also over the photograph.