Food and Drug Administration
57404077470Republic of the PhilippinesDepartment of HealthFOOD AND DRUG ADMINISTRATION00Republic of the PhilippinesDepartment of HealthFOOD AND DRUG ADMINISTRATIONCENTER FOR DRUG REGULATION AND RESEARCHINITIAL ( FORMCHECKBOX ) / AMENDMENT ( FORMCHECKBOX )SELF-ASSESSMENT FORM FOR SALES PROMO PERMITAPPLICANT NAME:APPLICANT ADDRESS:DTN:O.R. No. / Ref.No.:Amount Paid:Sales Promo Permit No.:Directions:Fill out the form by ticking the applicable column. Provide remarks on the client’s column when necessary.DOCUMENTARY REQUIREMENTS:YesNoREMARKSIntegrated Application FormIs the application form properly filled out? FORMCHECKBOX FORMCHECKBOX Intent LetterIs the request clear and within the scope of sales promo? FORMCHECKBOX FORMCHECKBOX Is the letter signed by the applicant’s approving authority? FORMCHECKBOX FORMCHECKBOX List of Participating ProductsIs the list of participating products (Sheet 3) provided in excel format? FORMCHECKBOX FORMCHECKBOX Copy of valid CPR/CPN RegistrationAre all the participating products duly registered or in the process of renewal? FORMCHECKBOX FORMCHECKBOX Is/are there participating product/s with CPRs/CPNs that will expire soon or within 6 months? Identify, if applicable. FORMCHECKBOX FORMCHECKBOX Information SheetIs the promo title not offensive, obscene, scandalous, against public moral and/or misleading? FORMCHECKBOX FORMCHECKBOX Is the requested promo duration acceptable? FORMCHECKBOX FORMCHECKBOX InitialAmendmentIs the promo coverage clearly indicated and within acceptable venue? FORMCHECKBOX FORMCHECKBOX InitialAmendmentIs the promo mechanic acceptable or compliant with existing rules and regulations? FORMCHECKBOX FORMCHECKBOX Amendment, if applicable: Collateral/ Promo MaterialsIs/are there collateral material/s used? FORMCHECKBOX FORMCHECKBOX InitialAmendmentIs/are the collateral material/s misleading, vague, and not compliant with existing rules and regulations? FORMCHECKBOX FORMCHECKBOX --- To be filled out by CDRR Personnel ---Decision:Remarks: Remarks: Approval FORMCHECKBOX Denial FORMCHECKBOX Clarification FORMCHECKBOX Name & Signature:Evaluator:Supervisor:Date: ................
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