Online Dealership Application

Owned By/Authorized Representative: FullName *

PIN *

Trade License no. with last date of renewal *

License/Token No. of local police Authority (if applicable)

License No. ( if any) issued By the Health Officer of the municipal Corp./Municipality or such Other Agency of the Locality

Present Nature of business *

Approx Quantity of intake per week of different products

Whether there is a Deep Freezer Refrigerator in the shop and its capacity

Special Mention/Remarks from Applicant Side *(optional if any, max. 300 characters)

FSSAI License * :     Certificate Already Issued Applied Recently

As per the directives of FSSAI authority, under Govt. of India, an online application for fssai (‘license’ /‘registration only’ depending upon the turnover) is to be made at https://foscos.fssai.gov.in/, by the Applicant before issuance of the dealership.

If the applicant show the document that he/she applied for FSSAI, WBLDC management will be considered his/ her application.

I/We, do hereby ACCEPT the Terms & Conditions for dealership.

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