APPENDIX ‘A’ 1[FORM I] [See rule 4(l)] (Memorandum to the Director, Central Food Laboratory) 1. Amended by S.R.O. 2755, dated 24th November,1956 and G.S.R. 1340, dated 4th November,1967. From:- To The Director, Central Food Laboratory, No..................…………………. dated the...............…………….. 19 1. I send herewith, under the provisions of Sec. 13 (2) of the Prevention of Food Adulteration Act, 1954, sample(s) of a food purporting to be for test or analysis and request that a report on the result of the test or analysis may be supplied to this Court: 1. Distinguishing No. on the container and other covering. 2. Particulars of offence alleged. 3. Matter on which opinion required 1[2. A fees of Rs. 200 for analysis of the sample is enclosed vide Demand Draft for Rs. 200 drawn in favour of the Pay and Accounts Officer, Central Food Laboratory, Directorate General of Health Services, Calcutta, payable at Bank of Baroda, 4, India Exchange Place, Calcutta-700001. The Director, Central Food Laboratories, on receipt of the Demand Draft from the Court shall immediately send the same to the Central Food Laboratory, 3, Kyd Street, Calcutta-700016 for deposition in respective Receipt Head.] A copy of memorandum and the specimen impression of the seal used to seal the container and the cover are sent separately by registered post. 2[Magistrate Ist class / Presidency3 Magistrate.] 1. Subs. By G.S.R. 91 (E), dated 26th February, 1995. 2. Subs. by S.R.O. 2755, dated 24th November, 1956. 3. See now the “Metropolitan Magistrate”. 1[FORM I-A [See rule 4(l)] 1. Ins. by G.S.R. 618 (E), dated 16th May. 1988 (w.e.f 16th May, 1988). From:- ...........…………………………………………. ….………………………………………………. To The Director, Central Food Laboratory, No………………………………. Dated the…………………… MEMORANDUM 1. I send herewith under the provision of Sec.6 (2) of Prevention of Food Adulteration Act, 1954, or Cl. (a) or rule 3 of the Prevention of Food Adulteration Rules, 1955, Sample(s) of a food purporting to be for test or analysis and request that a report on the result of test or analysis may be supplied to the undersigned: 1. Distinguishing No. on the container and outer covering. 2. Matter on which opinion required. 1[2. A fees of Rs. 200 for analysis of- the sample is enclosed vide Demand Draft for Rs. 200 drawn in favour of the Pay and Accounts Officer. Central Food Laboratory. Directorate General of Health Services, Calcutta, payable at Bank of Baroda, 47, India Exchange Place, Calcutta-700001. The Director, Central Food Laboratories, on receipt of’ the Demand Draft from the Court shall immediately send the same to the Central Food Laboratory,3. Kyd Street, Calcutta-700016 for deposition in respective Receipt Head.] 3. A copy of’ memorandum and the specimen impression of the seal used to seal the container and the cover are sent separately by Registered post. Customs Collector/Authorised Officer (Seal)] 1. Subs. by G.S.R. 91 (E), dated 26th February, 1995. 1[FORM III [See rule 4 (5)] 1. Subs. by G.S.R. 133, dated 23rd January, 1973. 1[Certificate No Certified that the samples(s) bearing number purporting to be a sample/samples of………..received On…………………... with Memorandum No dated……….. from………… was in a condition fit for analysis and has/have been tested/analysed and that the result/results of such test(s) analysis is/are stated below : ..………… ………….. 2[…………. and I am of the opinion that……………………………….] 2. The condition of seals on the container and the outer covering on receipt was as follows: Place ……… Director Date ………. Central Food Laboratory.] 1. Ins. by G.S.R. 1340, dated 24th October, 1961. 2. Added by G.S.R. 293 (E), dated 23rd March, 1985. 1(FORM III [SEE RULE 7 (3)] REPORT BY THE PUBLIC ANALYST 1. Amended by G.S.,R. 425, dated 16th April, 1960. Report No…………. I hereby certify that I Public Analyst for duly appointed under the provision of the Prevention of Food Adulteration Act, 1954, received on. .................. the …………. Day……….. of ……… 1 9 ……….. from 1[a sample of .. .......... bearing code number and serial number………. of the Local (Health) Authority, for analysis,] properly sealed and fastened. 2[The seal fixed on the container 3[and the outer cover] of the sample tallied with the specimen impression of the seal separately sent by the Food Inspector and the sample was in a condition fit for analysis.] I further certify 4[l have/had caused to be, analysed the aforementioned sample. and declare the result of the analysis] to be as follows: …………………………………………............... and am of the opinion that Signed this………………………….. day……………………………… of ……………………………………….. 19…………………………… Address :- (Signature) ………… Public Analyst.] 1. Subs. by G.S.R. 293 (E), dated 23rd March, 1985 for the words “a sample of for analysis”. 2. Subs. by G.S.R. 1533, dated 8th July, 1960. 3. Ins. by G.S. R. 1417, dated, 20th September, 1976 published in the Gazette of Indio, Pt. II, dated 2nd October, 1976. 4. Subs. by G.S.R. 425, dated 4th April, 1960. FORM IV (See rule 10) 1[To (Name and address of the vendor) ................................... ……………………… ................................... Whereas* intended for food which is in your possession appears to me to be adulterated/ rnisbranded ; Now, therefore. under subsection (4) of Sec. 10 of the Prevention of Food Adulteration Act, 1954 (37 of 1954). I hereby direct you to keep in your safely custody the said sealed stock subject to such order as may be issued subsequently in relation thereto. Place ……… Food Inspector Date……….. Area……..] *Here give the name of article of food. 1. Ins. by G.S.R. 1211, dated 9th December, 1958. 1[FORM IV-A (See rule 10) BOND OF SURELY 1. Ins. by G.S.R. 1533, dated, 8th July, 1968. Know all men by these presents that two (i)…………………………………….. son of ……………resident of………………….. and (ii)…………son of……………… resident of …………………………… Proprietors/partners of M/S…………… hereinafter called the vendor(s) and (iii)…………………………son of ……………..resident of …………………. and (iv) …………………………son of ……………..resident of ………………….. hereinafter called the surety/sureties are held and firmly borne up to the President of India /Governor of hereafter called the Government in the sum of……………………. rupees to be paid to the Government, for which payment will and truly to be made, we firmly bind ourselves jointly and severally by these presents. Signed this day of one thousand nine hundred and……………………………… Whereas Shri……………..Food Inspector has Seized………… (here insert the description of materials together with number/quantity and total price hereinafter referred to as the said article) from (specify the place). And whereas on the request of the vendor(s) the government agreed to keep the said article in the safe custody of vendor(s) on the condition of the vendor(s) executing a bond in the terms hereinafter contained and supported by surety/two sureties which the vendor(s) has/have agreed to do. Now the condition of the above written obligation is such that if in the event of the vendor(s) failure to produce intact the said article before such Court or authority and on such date(s) as may be specified by the said Food Inspector from time to time the vendor(s) and/or surety/sureties forthwith pay to the Government on demand and without demur a sum of rupees the said bond, will be void and of no effect. Otherwise the same shall be and remain in full force and virtue. These presents further, witness as follows:- (i) The liability of the surety/sureties hereunder shall not be Impaired or discharged by reason of time being granted by or any forbearance act or omission of the Government whether with or without the knowledge or consent of the sureties or either of them in respect of or in relation to all or any of the obligations or conditions to be Performed or discharged by the vendor(s).Nor shall it be necessary for the Government to sue the vendor(s) before suing the sureties or either of them for the amount due hereunder. (ii). This bond is given under the Prevention of Food Adulteration Act, 1954, for the performance of an act in which the public are interested (iii) The Government shall bear the stamp duty payable on these present. In witness whereof these presents have been signed by the vendor(s) and the surety/sureties the day hereinabove mentioned and by Shri on behalf of the President of India of the date appearing below against this signature. Witnesses :- 1. (Signature) (Name and address) 2. (Signature) (Name and address) Signature……………… (Vendor) Signature……………… (Vendor) Signature……………… (Surety) Signature…………….. (Surety) For and on behalf of the President of India/Governor of………………... Signature………………………… (Name and designation)………….. FORM V (See rule 11) 1 [TO (Name and address of the vendor) ................................…………… ................................…………… The stock of article of food detailed below has this day been seized by me under the provisions of sub-section (4) of Sec. 10 of the Prevention of Food Adulteration Act, 1954 (37 of 1954), from the premises Of:………………………………… situated……………………………….. At…………………………………………… Details of article of food seized. Place…………. Food Inspector Date ………… Area………….] 1. Ins. by G.S.R. 1211, dated 9th December, 1958. FORM VI (SEE RULE 12) TO, .............................. ........................….. I have this day taken from the premises of ………………………………… situated at………………samples of the food specified below to have the same analysed by the Public Analyst, for………………………………….. Details of food : 1[Code Number and Serial Number Of Local (Health) Authority] Place …………… Food Inspector, Date ……………… Area………… 1. Ins. by G.S.R. 618 (E),dated 16th May,1988. 1[FORM VI-A (See rule 12-A) FORM OF WARRANTY 1. Subs by G.S.R 1533, dated 8th July, 1968. Invoice No: Place : From : Date : To, Date of sale Name and quality 1 [Batch No. of Quantity Price of article/Brand Code No. Name, if any 1 2 2-A] 3 4 I/We hereby certificate that food/foods mentioned in this invoice is/are warranted to be of the nature and quality which it/these purports/purport to be. Signature of Manufacturer/Distributors/Dealer Name & Address of Manufacturer/Packer (in case of packed article). 2[Licence No. (wherever applicable)] 1. Ins by G.S.R. 1417, dated 2nd October, 1976. 2. Subs. By G.S.R 1533, DATED 8TH July, 1968. 1[FORM VI-B (See rule 44-B) DECLARATION I/We on behalf of………………………………………………. solemnly declare that the ghee used by me/us on behalf of…………………………………..in the preparation of…………………. confectionery (including sweetmeats) is/was for a tin containing ghee of origin and having “AGMARK” seal. The said tin pertains to batch No……………………………... and was purchased by me/us on Behalf of…………………………………………………. from Shri/Shrimati / Kumari/M/s ……………………….. on the…………………as per invoice/cash/credit memo No ……………………. Dated……………………… Date……….. Place ………... Signature of trader/ traders.] 1. Subs. by G.S.R. 1533, dated 8th July, 1968. FORM VII (See rule 17) MEMORANDUM OF PUBLIC ANALYST From .............................. ..........…………… To The Public Analyst .............................. .............................. No………………………. dated the………………………. 19 MEMORANDUM The sample described below is sent herewith for analysis under Cl. (b) of sub-section (1) of Sec. 10 and/ 1[for Cl. (c) of sub-section (1) of Sec.11 of the Prevention of Food Adulteration Act, 1954]: 2[(l) Code number and serial number of Local (Health) Authority). 3[(2) * * * * ] (3) Date and place of collection. (4) Nature of article submitted for analysis. (5) Nature and quantity of preservative, if any, added to the sample. 4[2. A copy of this memo and specimen impression of the seal used to the packet of sample is being sent. separately by 5[***]post / hand. Food Inspector, Area…………] ------------------------------------------------------------------------------------------------------------------------------------ *Strike out whichever is not applicable. ------------ 1. Subs. By G.S.R. 367 (E), dated 23rd March, 19889 March, 1988 (w. e .f 23rd March, 1988 2. Subs. by G.S.R. 293 (E), dated 23rd March,1985,for the figures and words “(i) Serial number of the sample “ 3. Omitted by G.S.R.618 (E), dated 16th May, 1988. 4. Amended by S.R.O 2755, dated 24th November, 1956). 5. Omitted by ibid, for the words “registered”. 1[FORM VIII (SEE RULE 12-B) NOMINATION OF PERSONS BY A COMPANY Notice is hereby given that Shri/Smt Director/Manager of the (Name of the company) has been nominated by the company by a Resolution passed at their meetings held on at to be in charge of, and responsible to, the said company for the conduct of the business of the said company or establishment/branch/unit thereof and authorized to exercise all such powers and take all such steps as may be necessary or expedient to prevent the commission by the said company of any offence under the Prevention of Food Adulteration Act, 1954. A certified copy of the said Resolution is enclosed. Place ………… Managing Director/Secretary Date …………… (Name of the company) NOTE:(Score out the said portion not applicable). I accept the above nomination in pursuance of sub-section (2) of Sec. 7 of the Prevention of Food Adulteration Act, 1954 and rule 12-B of the Rules made thereunder. Place………. Managing Director/Secretary Date……….. I hereby acknowledge receipt of the above nomination. Place………… Signature of the Local (Health) Date ………. Authority.] 1. Ins. by G.S.R. 4 (E). published in the gazette of India, Extraordinary. Pt.II, 3(i), dated 4th January,1977.
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