Registration / eocks
{See Reguiation 2-1.1(5))
(Beat 2.1115) 9 tera)
d q
Government of Kernataka
Soars ears
Registration under FSS Act,2006
SPOT ST crab, sen OOaS Reccd
Reglstration No / staoties xxl, : 21
4. Name and address of applicant:
Serer sed mw oes
19380000597
RANGANATHA. P. 0 / KARANM FAMILY RESTAURAN
(NO-721, HEROHALLT CROSS, MAGADAI MAIN nom
SESIMANTHAPURA, BANGALORE. Yeshwanthonen’
8.8.6.2 North (Karnataka), - se009%
2 Address of location where food business is to
S722, HEROHALLE CROSS, MaADst Hain ROAD
be conducted Premises: BE UWANTHAPURA, BANGALORE., Yeshwanthe sen
Od mad nibs WV/endeS ova: 8.BM.P North (karnataka), - S600:
3. Kind of Food Business : Food vending establishment
Sysrce oo: :
wurants
4. Photo Identity Card (Detaite) :
act ccterieh Sek
ct (oes Aschear cars
the pay eae sericae is issued under and is subfectad to {5c provision of FSS Act, 2006 all of
Ie DEL food business/ ok gees BSaeF ore, Beh, 200eKa.g
Sep Aeosstevid easnonaic,
which must be co
2 Siebocd ounce wey ae
Place /qv:
Date'y Bxret:08/03/2019
Validation and Renewe!
O68 ti) ssoeds
; fgnature ot]
eel Petiod of Renewal(eep | Hems of food Manutacturea [Signature of]
persica Date) oh Registration ree pala handied | Registering |
w=] sonstatewns oan, | “mctaten fee
| esseaaecr td anneyaee| Meee
; = es
| ee Seoty xb
| Please refer to annexure for
_detaiis,
8/93/2019 4 Year(s) a
£07/03/2020)
Pets / 90)