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Republic of the Philippines

Department of Agriculture FOR AFVDBCD-BAI USE ONLY


Bureau of Animal Industry
ANIMAL FEEDS, VETERINARY DRUGSAND Establishment License Number
BIOLOGICS CONTROL DIVISION
SectionVisayas Ave., Diliman, Quezon City

APPLICATION FOR VETERINARY BIOLOGIC


ESTABLISHMENT PERMIT/LICENSE

INSTRUCTION: Submit three (3) copies of application 1. Type of Application


for each establishment. If additional space is needed,
attach additional sheets and refer to item number. ‫ ڤ‬Initial
Enclose supporting documents ‫ ڤ‬Renewal

2. Date Received: ________________

3. Name and complete address of applicant:

4. Address for Official Mail:

5. If initial application, enclose a complete BAI-LSD Form 1 for one (1) product

6. If change of license, explain purpose for change:

7. Type of Organization 8. Nature of business


‫ ڤ‬Corporation ‫ ڤ‬Biological Manufacturer
‫ ڤ‬Partnership ‫ ڤ‬Biological Importer
‫ ڤ‬Individual Proprietorship

8. Principal Officers or Partners

Name Title Business Address


1.
2.
3.
4.
5.

9. Laboratory/Warehouse Address (es)

10. Brand Name of biologic and forecasted quantity to be Manufactured/Imported (State Country of Origin)for manufacturer, importer LTO applicant or name of
supplier/source of products for distributor, retailer applicant

RF FVDB-03 Application for Veterinary Biologic Page 1 of 2


Revise No. 00
October 16, 2017
CHECKLIST FOR SUPPORTING MATERIALS

A. With this
Items Submitted Application B. Date of C. Date of Final Remarks
(mark with Submission Submission
check)

11. Articles of
Incorporation

12. Certification of
Registration with
SEC

13. List and


qualification of
personnel

14. Blue Prints of


Building

15. List of Facilities and


Equipment (generator,
refrigerator, ouside, inside
thermometer, waste disposal
equip., etc.)

16. BAI-AFVDBCD
Form ______

17. Others (Pls.


Specify) Mayor s
Permit

CERTIFICATION

In accordance with the prevailing requirements and regulations is hereby made for a permit to maintain an establishment for
the importation/preparation of animal biological products for the use in the diagnosis, prevention and treatment of diseases of domestic
animals. If a permit/license is issued by the Bureau under this application, the permittee/licensee expressly agrees to comply with the
provisions of the said requirements and regulations and all the rules and orders of the Bureau issued pursuant thereto relating to the
operations of such establishment and the importation/preparation, testing and distribution of animal biological products
imported/prepared therein and that the animal biological products will not be labeled or advertised so as to mislead or deceived the
purchaser in any particular.

18. Signature of Authorized Official 20. Title 21. Date Signed

NOTE: Registration Certificate shall be displayed conspicuously in the place of business of the
company concerned and readily visible to the public.

RF FVDB-03 Application for Veterinary Biologic Page 2 of 2


Revise No. 00
October 16, 2017