Republic of the Philippines

Department of Health
Food And Drug Administration
Civic Drive, Filinvest City, Alabang, Muntinlupa City

Order of Payment
Application Details:
Date: 2020-12-03
Type: Amendment
Account No: 4000007239603
Product Details:
Brand Name: KOZY COFFEE BLEND
COFFEE DRINK MIX WITH COLLAGEN, GARCINIA CAMBOGIA
Product Name: EXTRACT, GREEN COFFEE BEAN EXTRACT, L-CARNITINE,
SALACIA CHINENSIS EXTRACT
Type of Food Product: High Risk Food Product
HRK2. Herbs and botanicals and/or Products with other nutritional
Food Categorization:
substances and/or combination as Conventional Food Product
Company Name: ZIENAC PHARMACEUTICAL TRADING
UNIT 401, AJBEL BLDG., 9127 SAN ANTONIO AVE, SAN
Company Address: ANTONIO VALLEY 1, SAN ANTONIO, PARANAQUE, METRO
MANILA
Manufacturer Name: GREENPLUS CORPORATION
Manufacturer 1 CHAMPACA ST. CERIS 1 VILLAGE, CANLUBANG, CALAMBA,
Address: LAGUNA
Supplier Name:
Supplier Address:
Packaging Material: PRINTED LAMINATED FOIL
Complete List of Ingredients:
Name
NON-DAIRY CREAMER 44.550%
MALTODEXTRIN 36.455%
INSTANT COFFEE POWDER 17.370%
SILICON DIOXIDE 1.000%
STEVIA EXTRACT 0.500%
COLLAGEN 0.025%
GARCINIA CAMBOGIA EXTRACT 0.025%
GREEN COFFEE BEAN EXTRACT 0.025%
L CARNITINE 0.025%
SALACIA EXTRACT 0.025%
Order of Payment:
Application Fee: 200
Legal Reasearch Fee: 10
Validity (Years): 5
Amount Due: 210
BancNet Amount: 225
If payment is made using Bancnet Online Bills Payment Facility (www.bancnetonline.com), an
additional Php15.00 should be included to the amount due, thus, the Total Amount to be Paid is PHP 225.