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Application Form - Sangkap Pinoy Seal
FDA application form for sangkap pinoy seal
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: QWP-008-020-01-Annex-07
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF HEALTH
FOOD AND DRUG ADMINISTRATION
Civic Drive, Filinvest Corporate City
Alabang, Muntinlupa City
SANGKAP PINOY SEAL PROGRAM
APPLICATION FORM
(This form should be accomplished by applicant in duplicate)
Date: ____________
I.
General Information
Name of Applicant-Firm: ________________________________________________
Business Address: ______________________________________________________
Telephone No. : _____________________________ Fax No. : __________________
Plant Factory Address (If there are more than one plant site where the product is
manufactured, identify the locations of the other processing plant. Use separate sheet
if necessary):
_____________________________________________________________________
_____________________________________________________________________
Telephone No. : _____________________________ Fax No. : __________________
Product Category Applied For : ___________________________________________
Brand Name in the Market : ______________________________________________
Fortificant Used:
Chemical Form :
____________________________
____________________________
________________________
________________________
Packaging Types and Sizes
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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QWP-008-020-01-Annex-07
II. Checklist of Documentary Requirements (Please check if the following are
submitted):
License To Operate (certified true copy)
Report of analysis from FDA Recognized Laboratory
Product Information
List of Ingredients
Nutrient Profile (in terms of %RDA per serving or per 100
grams. If the product is not ready-to-eat in terms of the
following):
___
___
___
___
___
___
___
___
___
Energy Value (kilocalories)
Protein
Fat
Carbohydrates
Vitamin A
Iron
Iodine
Dietary Fiber
Other vitamins/ minerals present in significant levels
i.e 10% RDA
Schematic diagram of the manufacturing process
Storage and distribution conditions
Instruction for handling by customers
End product specifications e. g. Physico-chemical, microbial
properties or sensory attributes
Estimated shelf life (with appropriate information on how this
was determined)
Reference materials attesting to the efficacy & bioavailability
of the fortificant
Product labels (current and proposed)
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QWP-008-020-01-Annex-07
III. Application Fee
Amount Paid: ________________
O. R. No. : __________________
Date Issued : ________________
Submitted by:
________________________________________________
Name and Signature by duly Authorized Representative
________________________________________________
Position of Duly Authorized Representative
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