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Fssai nomination form ix

FORM NO.IX

(Form of Nomination - Refer rule 2.5.1)

NOMINATION OF PERSONS BY A COMPANY

Being the proprietor or a signatory authorized by the board of directors of the company in terms of Rule 2.5.1 (2), I do hereby gives notice that the following persons(s) is/are nominated as the person(s) in charge of establishment, branch or the unit mentioned against the name of the person(s) and shall be responsible and liable for food safety or any contravention of the Act and rules/regulations or directions issued thereunder in respect of the concerned establishment/branch/unit. The person(s) shall take all such steps as may be necessary to prevent the commission by the Company of any offence under and comply with the provisions of Food Safety and Standards Act, 2006 and the Rules and Regulations made thereunder.

Branch wise/office wise nomination .

Establishment/branch/unit name
1. ___________
2. ___________
3. ___________

Name and Sign of Person i/c
1. ___________
2. ___________
3. ___________


A certified copy of the resolution of the board regarding the authorized signatory, (DATE) is enclosed.


For XYZ Ltd./Private Ltd.

Place: ______

Date: __/__/____


1. Authorized signatory of the company


Place: ____

Date: __/__/____

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