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Local Fertilizer Product Registration
FPA registration application form for local fertilizer product
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Annex 16
Form no.
Revision no.
2
Date
09.24.2018
Author
S.A.Binobo
J.B.Lansangan
Page
APPLICATION FOR LOCAL FERTILIZER PRODUCT
REGISTRATION
FPA-FRD-F01
Approved by
Document title
1 of 2
Reminder: Please fill out the form completely and legibly
Contact person
Contact number
E-mail address
New
Renewal
:
:
:
Date Received
Date Processed
Application No.
Amount Paid
OR Number
OR Date
CPR no.:
Expiry date:
(to be filled out by FRD)
1.
PRODUCT INFORMATION
a.
b.
Brand/Trade Name
Type of Product (e.g. Inorganic, raw material)
c.
Guaranteed Composition of Product
(e.g. N=14%, P₂O₅=14%, K₂O=14%)
:
:
:
-
(Please indicate the proper units e.g. %w/w,%w/v, ppm)
2. COMPANY INFORMATION
a. Name of Company
b. Business Address and Tel. No.
Head office
:
:
Telephone no.
Telephone no.
Location of warehouse
3.
1.
2.
3.
4.
:
Telephone no.
Location of Plant
:
Telephone no.
Regional/Provincial office
:
:
:
:
:
LIST OF MATERIALS/RAW MATERIALS
6.
7.
8.
9.
5.
11.
12.
13.
14.
10.
15.
1.
4.
7.
2.
3.
5.
6.
8.
9.
4.
5.
TARGET USERS/CROPS
FPA ACCREDITED RESEARCHER HANDLING THE EXPERIMENT/FIELD TEST:
(Surname)
(First name)
(M.I.)
Annex 16
Form no.
6.
a.
Administrative
i.
Interest charges
j.
2 of 2
Total Manufacturing Cost
h.
J.B.Lansangan
Fixed cost/plant overheard
g.
S.A.Binobo
Total Variable Manufacturing cost
f.
Author
Utilities (Power/Fuel)
e.
09.24.2018
Direct Labor
d.
Date
Direct Raw Materials
c.
2
COST COMPONENTS AND PRICES
Unit of measure
(Please state if in metric ton, liter, etc.)
b.
Revision no.
Page
APPLICATION FOR LOCAL FERTILIZER PRODUCT
REGISTRATION
FPA-FRD-F01
Approved by
Document title
Others (specify)
Total cost
k.
Manufacturer’s Mark-up
l.
Ex-factory Price
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 Authorized Representative
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 _______________________,
Philippines.
NOTARY PUBLIC
Doc. No.
Page No.
Until
Book No.
PTR NO.
Series of
(Original should bear documentary stamp)
