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)

Affidavit of Compliance with FDA Requirements on the Use of Certain Food Chemicals

(Affidavit of Compliance with FDA Requirements for Renewal of FDA License with Change of Address)

AFFIDAVIT / CERTIFICATION

I, _____________, Filipino, of legal age, (single / married / widow), and a resident of _____________, Philippines, after being duly sworn in accordance with law, depose and state:

That I am the __position__ of __name of company__, a (single proprietorship / domestic corporation) registered under the laws of the Republic of the Philippines, and which is engaged in the Food Processing/Manufacturing Business, particularly in the manufacture of _____________ food products;

That the said company has been granted a License to Operate by the Bureau of Food and Drugs (FDA) under Licence No. _____________ issued on _____________;

That the company is presently applying for a renewal of its FDA license (or a new FDA Licence because of its change of business address from _____________ to _____________, Philippines);

That I hereby certify that the company is using the following food chemicals: (enumerate and describe the food chemicals used);

That I hereby certify that we are getting our supply of the said food chemicals from _____________ Laboratory and are using the same in the accordance with proportions and limitations set by the said Laboratory, which are in compliance with the requirements of U.S. Pharmacoepia (USP) and Food Chemicals Codex (FCC) and are using only food grade ingredients;

That I am executing this Affidavit/Certification to attest to the truth of the foregoing and in support of our application for a new FDA license and for whatever other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.

Affiant