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Permit to Export Dangerous Drugs

PDEA application form for permit to export dangerous drugs

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APPLICATION FOR PERMIT TO EXPORT
DANGEROUS DRUGS AND/OR THEIR PREPARATION

_______________________
DATE

The Philippine Drug Enforcement Agency
PDEA Bldg., NIA Northside Road, Brgy. Pinyahan
Quezon City
Attention: Compliance Service
Gentlemen:
I, ___________________, duly licensed, and the authorized signatory of ___________________
__________________________________ with business address at ________________________
___________________________________________________ hereby apply for Authority to
Export Dangerous Drugs and/or their preparation.
the kind, quantity and other pertinent data of which are stated at the back hereof.
Further, I hereby bind myself to the condition that upon approval of subject permit / authority
to import, such shall be used for legal purposes only, strictly in accordance with the
provisions of Republic Act 9165, otherwise known as the "Comprehensive Dangerous Drugs
Act of 2002," and other implementing rules and regulations issued in connection therewith.
I HEREBY CERTIFY that all entries and attachments are true and correct and I shall be liable
for any wilful false statement made in this application form under the Revised Penal Code.
Very truly yours,

Document Attachments:




Certificate of Product Registration (CPR)
If no CPR, Application of CPR w/ FDA
Invoice / Proforma Invoice / Purchase Order
with Packaging Indicated
End-Use Declaration

Approved permits (for substances controlled in the
country of origin /destination) for pick u p by applicant
or authorized representative within 15 working days
from receipt thereof.

_____________________________
Name of Applicant
_____________________________
Contact No.

______________________________
PDEA License Number / Valid Until

a) Name an d quantity to be Exported ( maximum of
five[5] items only)
1. Brand Name, dosage Strenght, Form &
preparation:
Quantity (# of packages) :
No. of piece/s per package :

Packaging

2. Brand Name, dosage Strenght, Form &
preparation:
Quantity (# of packages) :
No. of piece/s per package :

Packaging

3. Brand Name, dosage Strenght, Form &
preparation:
Quantity (# of packages) :
No. of piece/s per package :

Packaging

4. Brand Name, dosage Strenght, Form &
preparation:
Quantity (# of packages) :
No. of piece/s per package :

Packaging

5. Brand Name, dosage Strenght, Form &
preparation:
Quantity (# of packages) :
No. of piece/s per package :

b) Controlled content of the finished preparation

Packaging

c) Name an d Address of Trader, Importer and
Ultimate Consignee
d) Invoice / PI / PO No. & Date
e) Expected Date of Departure
f) Customs Port of Departure
g ) Country of Destination
h) Purpose of subject exportation
i) Other Remarks

REMINDERS:
1. Submit permit application with complete requirements at least fifteen ( 15) working days in
advance before the transaction is to take place ( Sec. 10[ 1] , DDB Reg.3 s. 2003)
2. Regulatory fee per approved permit application (Sec. 2, DDB Reg. 7 s. 2007):
Php500.00( <1000Kg or L) ; Php1,000.00( >1000<5000Kg or L) ; Php1,500.00( >5000Kg or L)
3. Subject import permit is valid for six (6) month s from date of approval / authorize 1 ( Sec.
18[ 2] , DDB Reg. 3 s. 2003)
4. Subject authorized permits are not valid for articles before date of approval / authorized 1
5. Notify in writing of an y material changes in relation to the approved permit within five ( 5)
working days of its occurrence or prior to the arrival of con sign men t. Return subject permit
to PDEA for its appropriate amendment. ( Sec. 19, DDB Reg.3 s. 2003)
 
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