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Expansion of Establishment

FDA RONPD form for expansion of establishment

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Health
FOOD AND DRUG ADMINISTRATION

CENTER FOR DRUG REGULATION AND RESEARCH
RETAIL OUTLET FOR NON-PRESCRIPTION DRUGS
SELF-ASSESSMENT TOOLKIT FORM
EXPANSION OF ESTABLISHMENT

COMPANY NAME
:
COMPANY ADDRESS
:
ADDITIONAL SITE
:
ADDRESS
OWNER
:
LTO NUMBER
:
VALIDITY
:
Directions:
Fill out the form by ticking the applicable box. Provide remarks on the client’s column when necessary.
Submit in Portable Document Format (pdf) and word format duly signed by the pharmacist/owner.

DOCUMENTARY REQUIREMENTS:
1. Application Form
Is the integrated application form properly filled out?
Is it duly notarized?
Are the signatories of the application form the authorized
persons as required under the following circumstances?
(a) If single proprietorship – the owner as registered in DTI
(unless there is a different authorized person)
(b) If partnership/corporation – one of the incorporators or
authorized person as indicated in the board resolution
and/or Secretary’s Certificate
(c) If cooperative – authorized person indicated in the board
resolution and/or Secretary’s Certificate of the
cooperative
If the signatory is not the owner or one of the incorporators, as the
case may be:

Is there a board resolution or notarized Secretary’s
Certificate clearly identifying the person authorized to sign
for and in behalf of the owner or corporation submitted?
For government-owned establishments:






Is there an Order (or equivalent document) identifying the
person authorized to sign for and in behalf of the
establishment submitted?

2. Proof of Ownership
 Is the proof of ownership (e.g., contract of lease/sub-lease,
ownership title, etc) attached?
 Does it indicate the name of the applicant and address or
space leased/owned?
 Is it valid and duly notarized?
3. Proof of Payment
 Is the payment made according to the required fee?
 Is there a scanned copy of proof of payment (e.g FDA official
receipt, Landbank On-coll validated slip ) submitted?

REMARKS
Yes

No

CLIENT

FDA

Prepared by:
Position (Pharmacist / Owner):

--- To be filled out by client: --Signature:
Date:
--- To be filled out by RFO: ---

Decision:
Approval
Denial

Remarks:

Clarification

Inspection

Evaluated by:

Decision:
Approval
Clarification
Evaluated by:

Date:

Remarks:

--- To be filled out by CDRR: ---

Date:
 
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