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September 22, 2020

Dr. Rolando Enrique Domingo, DPBO


Officer-in-Charge
Food and Drug Administration
Department of Health

SUBJECT: APPLICATION FOR COMPASSIONATE SPECIAL PERMIT- REMDESIVIR

Dear Dr. Domingo,

As part of our efforts in managing patients with severe COVID-19 in our institution, we would
like to request for the Compassionate Special Use of Remdesivir 100 mg Lyophilized
Injection.

We would initially be needing no. vials of Remdisivir and it will be supplied by AJ Research &
Pharma Inc.

We are aware that FDA is not liable for any damage or injury arising from the use of the
unregistered drug.

Trust this finds you well and we would highly appreciate your positive response on this.

Thank you very much!

Kind regards,

NAME AND SIGNATURE OF PHYSICIAN


NAME OF INSTITUTION

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