A DETAILS OF FOOD BUSINESS OPERATOR ( FBO )

1.(a) name of the applicant : M/s American Food Corpoartion

1.(b) product name : NutriGene, Ampro-D ,ProDiet, ( Proprietary Food - Food & Dietary or Health Supplements )

2.(a) contact address : 19A,Ground Floor,Shanmuga Nagar, ( Incl.tel.no.& E.mail ) SIPCOT,Pudukkottai-622002

Tamil Nadu Phone : Mobile: 9944884990 Email : americanfoodcorporation@gmail.com

2.(b) Manufacturing Address : 19A,Ground Floor,Shanmuga Nagar,

SIPCOT,Pudukkottai-622002 Tamil Nadu

3. Previous License Details : Not Applicable ( New Registration & License )

B. PRODUCT DETAILS

For FSSAI Office use OnlyFOOD SAFETY & STANDARD AUTHORITY OF INDIAProduct Approval Application Form 1 ( a ) / ( d )

Date of Application

S.No. List of Ingredients In % S.No. List of Additives with INS No. In %1 Whey Protein Isolate 1 Maltodextrin2 Non-Fat Mlik Solids 2 Cocoa Powder3 Malt Extract Powder 3 Caramel Powder4 Soluble Fibre ( Apple ) 4

C.

DOCUMENTS TO BE ENCLOSED

1. Product Label / Prototype Label2. Certificate of Analysis of the product3. Shelf Life of the Product

Name & Signature of the Applicant

INDIAN FOOD CODE ( IFC ) DETAILSName of the product under IFC IFC No.Whey protein Isolate 13.6Non- Fat Milk Solids 13.6Malt Extract Powder 13.6Cocoa Powder 13.6Maltodextrin 13.6Soluble Fibre ( Apple ) 13.6Caramel Powder 13.6