AFCO TRADERS LTD.

AD GLOBAL Corp Eco Foods and More LTD

WINE AND GOURMET FOODS, ORGANIC BEAUTY PRODUCTS

H.5 –FDA- FOOD FACILITY INFORMATION

Please complete all fields

COMPANY INFORMATION
1
Legal Company Name
1.A
Company Name Suffix (LTD, Corp, SA, etc.)
2
Full Company Address Line 1
2a
Full Company Address Line 2
3 4
City Postal Code
5 6
Region State
Country
8 9
Telephone include Country Email
Code
10
Contact Name

1
11
Web Page http://

Page
12
TAX Number (VAT)
13
In Business since (Month/Year)
14
Parent Company (if Any)

Form H5. REV 04.01 2019.

 AFCO TRADERS LTD. AD GLOBAL Corp Eco Foods and More LTD
WINE AND GOURMET FOODS, ORGANIC BEAUTY PRODUCTS

FFMR MODULE INFORMATION

Write here the Information of the Person responsible for the FDA Process

15
First Name
16
Middle Initial
17
Last Name
18
Title in the Company :
19
Phone Number
20
FAX Number :
21
E-Mail Address:
Main Trade Name
22
Alternative Trade Names 1
23
Alternative Trade Names 2
24
Alternative Trade Names 3

2
25

Page
Alternative Trade Names 4

Type of Activity conducted on Facility MARK YES or NOT

26 27
Warehousing Low acidified Processor

28 29
Contract Sterilizer Labeler/Relabeler
Form H5. REV 04.01 2019.
 AFCO TRADERS LTD. AD GLOBAL Corp Eco Foods and More LTD
WINE AND GOURMET FOODS, ORGANIC BEAUTY PRODUCTS

30 31
Manufacturer/Processor Repacker/Packer
Write here the Products you manufacture

32
Product
33
Product
34
Product
35
Product
36
Product
37
Product
39
Product
40
Product

Comments

Please write here any information you want us to know about your products or your company

3
I declare that: I Appoint AD Global Corp or any of its subsidiaries to act as FDA registered Agent for the Company and, I have examined this

Page
document, and to the best of my knowledge and belief, all the information I have written in behalf on the Company I represent, is true, correct, and
complete.
Name of applicant: Date of application

Form H5. REV 04.01 2019.