eLTO FDA Representative Authorization



[COMPANY LETTERHEAD]

(DATE)

The Director General
Food and Drug Administration
Civic Drive, Filinvest City
Alabang, Muntinlupa City

Dear Director General,

In accordance with Republic Act No. 9711 and other related issuances, we (Company Name) with business address at ________________________________________________________ hereby authorize ___________________________________ ( Name of Company Representative) as the account holder of the eLTO and shall be responsible for all applications submitted through the eLTO system.

I here by undertake and warrant that the data and information submitted in connection with this application as well as other submissions in the future including variation are true, correct, and reflect the total information available.


_____________________________________________
(Owner/President/CEO/Authorized Officer)