1174 Sotto Yuvienco Bldg.
, General Luna Street, Paco, Manila
Telefax: 8522-3060
Email address: info@uroic.com
DATE
The Director General
Food and Drug Administration
Civic Drive, Filinvest City
Alabang, Muntinlupa City
Dear Director General:
We, URO Industrial Clinic, Inc. with business address at 1174 Sotto Yuvienco Bldg., General Luna
Street, Paco, Manila hereby authorizes Ms. Christine Marquez as the registered user/account holder of
RRD online authorization services for the issuance of License to Operate LTO (License to Operate LTO,
Certificate of Facility Registration CFR, Clearance for Customs Release CFCR, Certificate of Safety
Evaluation CSE) and shall be responsible for all the applications submitted through the RRD Portal
System.
We hereby declare and undertake that all the data and information submitted in connection with this
application, as well as other submissions in the future including variations are true, correct and reflect the
total information available.
Nicanor S. Montoya M.D.
(Owner / Legal Person of the Company)
SUBSCRIBED AND SWORN to before me, this ____ day of ____________ 20___ at
______________________________________.
__________________________
Notary Public
Doc No. __________
Page No. __________
Book No. __________
Series No. __________
