FERTILIZER & PESTICIDE AUTHORITY (FPA)

FPA BIOTECH SERVICES

Office of the Executive Director
(02)9200068

FPA USE ONLY

Application no._______________
Date Received________________
O/R No Filing Fee_____________
Date of Registration____________
OR No Regn Fees_____________
Registration No._______________
Remarks_____________________

APPLICATION FOR REGISTRATION

OF BIOTECH PLANT-INCORPORATED-PROTECTANT (PIP)
1.

Institution/ Business Name & Business Address

___________________________________________
____________________________________________
2.

Brand Name

________________________________________
3.

Name of active ingredient

________________________________________
4.

Registration Applied for:

New

5.

Renewal

Resubmission
Remarks__________________________________

PIP use category

Insecticide
Fungicide
Others, specify _____________________________________

6.

Name and address of manufacturer

__________________________________________________________________________________
7.

Applicants Signature/Authorized Representative

Name: _______________________
Title: ________________________
Signature: ____________________
REPUBLIC OF THE PHILIPPINES
PROVINCE OF________________
MUNICIPALITY OF ___________
Subscribed and sworn to before me this day of ___________,20____ at ________________________
Philippines, affiant exhibited to me his/her residence Certificate no. __________________issued
on________20_____ at ___________________, Philippines
Notary Public____________
Until____________________

(doc stamps)