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Authorization Letter
FDA letter of authorization
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Civic Drive, Filinvest Corporate City, Alabang, City of Muntinlupa 1781 Philippines
Date of Applied
*
dd
MMMM
yyyy
Name of the current Director
Director General
Food and Drug Administration
Civic Drive, Filinvest Corporate City, Alabang
City of Muntinlupa 1781 Philippines
Attention:
Officer-In-Charge
Policy and Planning Office
FDA Academy
I,
the undersigned, hereby authorize _________________________________________
(Name of the Company Owner/ General Manager)
( Name of QPIRA Applicant)
to act/ represent on our behalf in all manners relating to product application, including signing of all documents relating to these matters.
Any and all acts carried out by ________________________________________ on our behalf shall have the same affect as acts of our own.
( Name of QPIRA Applicant)
This authorization is valid until further written notice from __________________________________.
(Name of Company)
Company Owner/ General Manager
Signature over Printed Name
for more than 1 authorized company
I,
the undersigned, hereby authorize _________________________________________
(Name of the Company Owner/ General Manager)
( Name of QPIRA Applicant)
to act/ represent on our behalf in all manners relating to product application, including signing of all documents relating to these matters.
Any and all acts carried out by ________________________________________ on our behalf shall have the same affect as acts of our own.
( Name of QPIRA Applicant)
This authorization is valid until further written notice from __________________________________.
(Name of Company)
Furthermore, our company, _________________________ interposes no objection for __________________________ to represent other company
( Name of QPIRA Applicant)
(Name of the Company)
included in this form.
Company Owner/ General Manager
Signature over Printed Name
I,
the undersigned, hereby authorize _________________________________________
(Name of the Company Owner/ General Manager)
( Name of QPIRA Applicant)
to act/ represent on our behalf in all manners relating to product application, including signing of all documents relating to these matters.
Any and all acts carried out by ________________________________________ on our behalf shall have the same affect as acts of our own.
( Name of QPIRA Applicant)
This authorization is valid until further written notice from __________________________________.
(Name of Company)
Furthermore, our company, _________________________ interposes no objection for __________________________ to represent other company
(Name of the Company)
( Name of QPIRA Applicant)
included in this form.
Company Owner/ General Manager
Signature over Printed Name
For QPIRA Applicants only
FDAA-Form 2013-02/ Effectivity: 02 May- Rev. 0
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