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ID:39785856
大小:1.06 MB
页数:10页
时间:2019-07-11
《FDA FOOD FACILITY REGISTRATION》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、FormApproval:OMBNo.0910-0502;ExpirationDate:03/31/2013;SeePRAStatementonpage10.FDAUSEONLYDEPARTMENTOFHEALTHANDHUMANSERVICESFoodandDrugAdministrationDHHS/FDAFOODFACILITYREGISTRATION(Ifenteringbyhand,useblueorblackinkonly.)Date(mm/dd/yyyy)Section1–TYPEOFREGISTRATION1a.DOMESTICRE
2、GISTRATIONFOREIGNREGISTRATION1b.INITIALREGISTRATIONUPDATEOFREGISTRATIONINFORMATION1c.BIENNIALREGISTRATIONRENEWALFacilityRegistrationNumberPINIfupdateorbiennialregistrationrenewal,providetheFacilityRegistrationNumberandPINForupdateofregistrationinformation:CheckallthatapplyUnit
3、edStatesAgentChange-ForeignfacilitiesonlyandfurtheridentifychangesintheapplicablesectionsFacilityNameChangeSeasonalFacilityDatesofOperationChangeFacilityAddressChange(Seeinstructions)TypeofActivityChangePreferredMailingAddressChangeTypeofStorageChangeParentCompanyChangeHumanFo
4、odProductCategoryChangeEmergencyContactChangeAnimalFoodProductCategoryChangeTradeNameChangeOperatororAgentinChargeChangeAREYOUTHENEWOWNEROFAPREVIOUSLYREGISTEREDFACILITY?YesNo1d.If“Yes”,providethefollowinginformation,ifknown.Previousowner’snamePreviousowner’sregistrationnumberS
5、ection2–FACILITYNAME/ADDRESSINFORMATIONFacilityNameFacilityStreetAddress,Line1FacilityStreetAddress,Line2CityState(Ifapplicable;ifnot,skiptoProvince/Territory)Province/Territory(Ifapplicable)ZIPorPostalCodeCountryPhoneNumber(IncludeArea/CountryCode)FAXNumber(Optional;IncludeAr
6、ea/CountryCode)E-MailAddressFORMFDA3537(9/12)Page1of10PSCPublishingServices(301)443-6740EFDHHS/FDAFOODFACILITYREGISTRATIONSection3–PREFERREDMAILINGADDRESSINFORMATION-CompletethissectiononlyifdifferentfromSection2FacilityName/AddressInformation(OPTIONAL)NameStreetAddress,Line1S
7、treetAddress,Line2CityState(Ifapplicable;ifnot,skiptoProvince/Territory)Province/Territory(Ifapplicable)ZIPorPostalCodeCountryPhoneNumber(IncludeArea/CountryCode)FAXNumber(Optional;IncludeArea/CountryCode)E-MailAddress(Optional)Section4–PARENTCOMPANYNAME/ADDRESSINFORMATION(Ifa
8、pplicableandifdifferentfromSections2and3)Ifinformationisthesa
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