Академический Документы
Профессиональный Документы
Культура Документы
Department of Health
Food and Drug Administration
CENTER FOR DEVICE REGULATION, RADIATION HEALTH, AND RESEARCH
(former name : Bureau of Health Devices and Technology)
LICENSING AND REGISTRATION DIVISION
CDRRHR-2-L-02D
Revision No. 2
Date Effective: 15 April 2015
FIRST - That we are fully aware of the provisions of the Pharmacy Law, the Foods, Drugs, Devices, and
Cosmetics Act, the Generics Act of 1988, that we are aware of the specific requirements that the Operation
of______________________________________________________________________________shall be
under the IMMEDIATE AND PERSONAL SUPERVISION of the Pharmacist-In-Charge, the business hours
being from _______AM to ________ PM;
SECOND – that we agree to change the business name if there is already a validly registered name similar to
our business name;
THIRD – that we shall display our approved License to Operate (LTO) in a conspicuous place of our
establishments;
FOURTH - that we shall notify FDA in case of any change(s) in the circumstances of our application for a
License to Operate, including but not limited to change(s) of location, change of ownership, change of
pharmacist-in-charge, and change in medical device products;
FIFTH – and that I, the pharmacist-in-charge, am not and will not be in any way connected with any drug or
similar establishment/outlet;
WE execute this Joint Affidavit of Undertaking to confirm the truth of our declaration and our awareness of the
fore going duties and responsibilities among others.