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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

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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 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 अनुजिपत संखया / License Number: 12720052000673 1. Name & Registered Office address of Licensee / DYAUS MED HEALTHCARE PRIVATE LIMITED अनुजिपतधारी के पंजीकृ त कायारलय का नाम और पता: KNOWLEDGE AND INNOVATION CAMPUS, KHASRA NO.564 ABURPUR ROAD, MURADNAGAR Ghaziabad Uttar Pradesh 201206 2. Address of Authorized Premises / पािधकृ त पिरसरो का KNOWLEDGE AND INNOVATION CAMPUS,KHASRA पता: NO.564 ABUPUR ROAD, MURADNAGAR Ghaziabad Nagar Nigam Zone-8 Ghaziabad Uttar Pradesh 201206 3. Kind of Business / कारोबार का पकार: Manufacturer - Food or Health Supplements and Nutraceuticals etc. Manufacturer - General Manufacturing Trade/Retail - Supplier Trade/Retail - Marketer Trade/Retail - Distributor Trade/Retail - Wholesaler 4. Dairy Business Details / डेयरी कारोबार िववरण हेतु : No 5. Category of License / अनुजिपत का वगर: 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 अनुजिपत खाद संरका और मानक अिधिनयम, 2006 के अधीन अनुदत की गई और वह अिधिनयम के उपबंधो के अधयादीन है िजनका अनुजिपतधारी दारा अवशय पालन िकया जाना चािहए. Place / सथान: Ghaziabad Designated Officer Issued On / िदनांक: 10-12-2020 (Modified License) नािमत अिधकारी Valid Upto: / वैधता: 17-11-2025 (For details, refer Annexure) Annexures: 1. Product Annexure 2. Validity Annexure 3. Non-Form C Annexure 4. Conditions Of License Page 1 of 10 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. Page 2 of 10 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 अनुजिपत संखया / License Number: 12720052000673 Kind Of Business: Manufacturer - General Manufacturing Production Capacity(MT / Day): 2 Sl.No. Food Category Sub-Food Category Product Kind of Business 1 04 - Fruits and vegetables 04.2 - Vegetables Pickles made from Manufacturer - (including mushrooms and (including mushrooms vegetables or other General fungi, roots and tubers, and fungi, roots and edible plant material Manufacturing fresh pulses and legumes, tubers, pulses and including mushrooms and aloe vera), seaweeds, legumes, and aloe vera), and nuts and seeds seaweeds, and nuts and seeds 2 04 - Fruits and vegetables 04.2 - Vegetables Dehydrated Vegetables Manufacturer - (including mushrooms and (including mushrooms General fungi, roots and tubers, and fungi, roots and Manufacturing fresh pulses and legumes, tubers, pulses and and aloe vera), seaweeds, legumes, and aloe vera), and nuts and seeds seaweeds, and nuts and seeds 3 04 - Fruits and vegetables 04.2 - Vegetables Pickled Fungi Manufacturer - (including mushrooms and (including mushrooms General fungi, roots and tubers, and fungi, roots and Manufacturing fresh pulses and legumes, tubers, pulses and and aloe vera), seaweeds, legumes, and aloe vera), and nuts and seeds seaweeds, and nuts and seeds 4 04 - Fruits and vegetables 04.2 - Vegetables Vegetable Pulp/Puree Manufacturer - (including mushrooms and (including mushrooms with Preservatives for General fungi, roots and tubers, and fungi, roots and Industrial Use only Manufacturing fresh pulses and legumes, tubers, pulses and and aloe vera), seaweeds, legumes, and aloe vera), and nuts and seeds seaweeds, and nuts and seeds 5 04 - Fruits and vegetables 04.2 - Vegetables Pickles made from Manufacturer - (including mushrooms and (including mushrooms combination of fruits General fungi, roots and tubers, and fungi, roots and or vegetables or other Manufacturing fresh pulses and legumes, tubers, pulses and edible plant material and aloe vera), seaweeds, legumes, and aloe vera), including mushrooms and nuts and seeds seaweeds, and nuts and (Mixed) seeds 6 05 - Confectionery 05.2 - Confectionery Sugar boiled Manufacturer - including hard and soft confectionery (Soft General Page 3 of 10 Sl.No. Food Category Sub-Food Category Product Kind of Business candy, nougats, etc. Candy) Manufacturing other than food categories 5.1, 5.3, and 5.4 7 07 - Bakery products 07.2 - Fine bakery wares Biscuit Manufacturer - (sweet, salty, savoury) General and mixes Manufacturing 8 05 - Confectionery 05.2 - Confectionery Sugar boiled Manufacturer - including hard and soft confectionery (Hard General candy, nougats, etc. Candy) Manufacturing other than food categories 5.1, 5.3, and 5.4 9 05 - Confectionery 05.2 - Confectionery Lozenges Manufacturer - including hard and soft General candy, nougats, etc. Manufacturing other than food categories 5.1, 5.3, and 5.4 10 11 - Sweeteners, including 11.6 - Table-top Acesulfame Potassium Manufacturer - honey sweeteners, including General those containing high- Manufacturing intensity sweeteners 11 11 - Sweeteners, including 11.6 - Table-top Aspartyl Phenyl Alanine Manufacturer - honey sweeteners, including Methyl Ester General those containing high- (Aspertame) Manufacturing intensity sweeteners 12 11 - Sweeteners, including 11.6 - Table-top Sodium Saccharin Manufacturer - honey sweeteners, including (Food Grade) General those containing high- Manufacturing intensity sweeteners 13 11 - Sweeteners, including 11.6 - Table-top Calcium Saccharin Manufacturer - honey sweeteners, including (Food Grade) General those containing high- Manufacturing intensity sweeteners 14 11 - Sweeteners, including 11.6 - Table-top Sucralose Manufacturer - honey sweeteners, including General those containing high- Manufacturing intensity sweeteners 15 11 - Sweeteners, including 11.5 - Honey Honey Manufacturer - honey General Manufacturing Kind Of Business: Manufacturer - Food or Health Supplements and Nutraceuticals etc. Production Capacity(MT / Day): 2 Page 4 of 10 Sl.No. Food Category Sub-Food Category Product Kind of Business Product Approval Certificate 1 13 - Foodstuffs 99.7 - Functional Ingredients DIVINE Manufacturer - Food view intended for LEAVES or Health particular Supplements and nutritional uses Nutraceuticals etc. 2 13 - Foodstuffs 13.5 - Dietetic foods (e.g., SUGAR Manufacturer - Food view intended for supplementary foods for FREE or Health particular dietary use) excluding PRODUTS Supplements and nutritional uses products of food categories Nutraceuticals etc. 13.1 -13.4 and 13.6 Kind Of Business: Trade/Retail - Wholesaler Sl.No. Product(s) 1 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and legumes, and aloe vera), seaweeds, and nuts and seeds 2 07 - Bakery products 3 05 - Confectionery 4 11 - Sweeteners, including honey Kind Of Business: Trade/Retail - Distributor Sl.No. Product(s) 1 07 - Bakery products 2 05 - Confectionery 3 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and legumes, and aloe vera), seaweeds, and nuts and seeds 4 11 - Sweeteners, including honey Kind Of Business: Trade/Retail - Supplier Sl.No. Product(s) 1 07 - Bakery products 2 05 - Confectionery 3 11 - Sweeteners, including honey 4 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and legumes, and aloe vera), seaweeds, and nuts and seeds Kind Of Business: Trade/Retail - Marketer Sl.No. Product(s) 1 11 - Sweeteners, including honey 2 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and legumes, and aloe vera), seaweeds, and nuts and seeds 3 07 - Bakery products Page 5 of 10 Sl.No. Product(s) 4 05 - Confectionery Page 6 of 10 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 अनुजिपत संखया / License Number: 12720052000673 Validity From Validity Upto Issued On Fee Paid Type 18-11-2020 17-11-2025 18-11-2020 10000 INR New 18-11-2020 17-11-2025 10-12-2020 4000 INR Modification 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. The Application for renewal of license shall be submitted 30 days prior to the expiry date mentioned above after which Rs. 100 per day will be charged up to the date of expiry. Page 7 of 10 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 अनुजिपत संखया / License Number: 12720052000673 Person in charge of operations Name: AMIT SINGH ROHILA Qualification: B.PHARMA M.TECH MBA Contact No: N/A Mobile No: 9717166700 Email-ID: [email protected] Address: SH-280A, SHASTRI NAGAR, GHAZIABAD State: Uttar Pradesh District: Ghaziabad Pin Code: 201001 Photo Id Card: Aadhar Card Photo Id 634278518247 Photo Id Expiry N/A No: Date: 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: AMIT SINGH ROHILA Qualification: B.PHARMA M.TECH MBA Contact No: N/A Mobile No: 9717166700 Email-ID: [email protected] Address: SH-280A, SHASTRI NAGAR, GHAZIABAD State: Uttar Pradesh District: Ghaziabad Pin Code: 201001 Photo Id Card: Aadhar Card Photo Id 634278518247 Photo Id Expiry N/A No: Date: Place / सथान: Ghaziabad Designated Officer नािमत अिधकारी Issued On / िदनांक: 10-12-2020 (Modified License) Note: Any change in above details shall be immediately communicated to authorities.
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