Philippine Government Forms All in One Location
EUP - Experimental Use Permit for Fertilizer Efficacy Trial
FPA application form for experimental use permit for fertilizer efficacy trial
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APPLICATION FOR EXPERIMENTAL USE PERMIT FOR
FERTILIZER EFFICACY TRIAL
1 of 1
Reminder: Please fill out the form completely and legibly
1. PRODUCT INFORMATION
a. Brand/Trade Name
c. Guaranteed Composition :
(Please indicate the proper units e.g. %w/w, %w/v)
b. Product Classification
Plant Growth Promoter
(to be filled out by FRD)
2. COMPANY INFORMATION
a. Company name
b. Company address
c. TIN no.
d. Telephone no.
3. EFFICACY TRIAL INFORMATION
a. Brand/Trade Name
b. Test crop
c. Total amount of product needed
d. Inclusive dates for the duration of trial
e. Proposed treatment and method of application
f. Location of Trial
g. Name of Researcher/Accrediatation No.
h. Address of Researcher/Research institute/ Affliation
CONSENT TO PROCESS AND SHARE DATA
In compliance with the Data Privacy Act, I hereby give my consent to the Fertilizer and Pesticide Authority to share my contact details
to the public for whatever legal purpose it may serve.
Signature over Printed Name of the Contact Person
I HEREBY CERTIFY that the foregoing data and information including those in the annexes hereof are true and correct to the
best of my knowledge.
IN WITNESS WHEREOF, I have hereunto set my hand this _____day of ______year _________ at __________, Philippines.
Name and Signature of Firm’s President, Manager or
REPUBLIC OF THE PHILIPPINES
PROVINCE OF ______________________
MUNICIPALITY/CITY OF ______________
SUBSCRIBED AND SWORN TO before me this _____ day of ________ year _______ at ___________________, Philippines. Affiant
exhibited to me his/her Residence Certificate No. ______________ issued on _________________ at _______________________,
(Original should bear documentary stamp)