Annex D Application Form For Foreign Manufacturer GMP Inspection

ANNEX D
Application Form for

Foreign Manufacturer
GMP Inspection
• This form should be completed by the drug importer for each Foreign Drug
Manufacturer.
• Incomplete forms may be returned to the applicant. Please type or print in black pen.
• Any alterations must be initialed and dated.
• The completed form should be sent to:
Postal: The Director General

Food and Drug Administration
Civic Drive, Filinvest Corporate City,
Alabang, Muntinlupa City, Philippines
1
SECTION A
TO BE COMPLETED BY THE PHILIPPINE DRUG IMPORTER
Manufacturing is defined as engaging in any operation involved in the production of drugs

including preparation, processing, compounding, formulating, filling, packaging,
repackaging, altering, ornamenting, finishing, and labeling with the end in view of its storage,
sale or distribution. This also includes assembling (device), storage, sterilizing, testing or
release for supply of the goods or of any component or ingredient.
SPONSOR NAME:

SPONSOR ADDRESS:

CONTACT NAME:

TELEPHONE NO.:

FAX NO:

EMAIL ADDRESS:

Note: The sponsors must pay the cost of the inspection (based on the current fees and
charges) before the FDA GMP inspector leaves the Philippines, and the
manufacturer must agree to the inspection. Otherwise, the inspection will not
proceed.
SECTION B
TO BE COMPLETED BY OR ON BEHALF OF THE FOREIGN MANUFACTURER
MANUFACTURER’S NAME

OFFICE ADDRESS:

MANUFACTURING SITE ADDRESS:

CONTACT NAME:

TELEPHONE NO.:

FAX NO:

EMAIL ADDRESS:

SECTION B-1
PRODUCT DETAILS –Specify Specify the steps in manufacture that are Sterile
type of product to be inspected, eg conducted at this site, eg all steps in Yes/no
tablet, herbal tablet, capsules, cream, manufacture, packaging, release,
herbal extracts, condoms, gloves etc manufacture of dosage form etc
1.

2.

3.

4.

5.

6.

7.

8.

9.

SECTION B-2
TO BE COMPLETED BY OR ON BEHALF OF THE FOREIGN MANUFACTURER
KEY PERSONNEL INFORMATION
1. Person in charge of production *and /*or assembly.
Production:
Name:

*National Identification Number/Passport No.:

Designation:

Directly reporting to:

No. of years of relevant experience:

Assembly:
Name:


Designation:



2. Person in charge of quality control *and/*or quality assurance.
Quality Control:
Name:


Designation:



Quality assurance:
Name:


Designation:



3. Person who authorizes the release of products
Name:


Designation:



SECTION B-3
CONTRACT MANUFACTURER/ASSEMBLER INFORMATION
Contract manufacturer Contract Assembler

The contractors refer to those engaged by the Foreign manufacturer. If there is more than one
contractor, please specify all the contractors and provide all the relevant details as required
below
1. Name of Company:

Company address:

Telephone No.:

Fax No.:

Official e-mail address:

2. *Manufacturing/ Assembling Site
Address:

Telephone No.:

Fax No.:

Official e-mail address:

3. Scope of *Manufacturing / Assembling Activities (please specify):

CONTRACT TESTING LABORATORY INFORMATION
Please state NIL if your company does not engage the services of any contract testing
laboratories.
If there is more than one contract testing laboratory, please specify all the contract testing
laboratories and provide all the relevant details as required below.
1. Name of testing laboratory:

Address:

Telephone No:

Fax No:

Official E-mail Address:

2. Types of analytical tests performed:

3. Is the contract testing laboratories accredited to ISO/IEC 17025 or other quality system
standards? If so, please specify the standard and the scope of accreditation. Please attach the
certificate of accreditation.

PRODUCT DETAILS –Specify Specify the steps in manufacture that are Sterile
type of product to be inspected sub-contracted at this site Yes/no
1.

2.

3.

4.

5.

6.

7.

8.

9.

SECTION C
Additional Information
INITIAL INSPECTION-Request for Inspection
In order to schedule a GMP inspection by the FDA, the applicant should indicate an
approximate date from which they will be ready. If this date changes after the application is
submitted, the FDA GMP Inspectors should be notified as soon as possible.
Approximate date when ready for inspection

The actual date of the inspection will be advised to the company by the inspector assigned to
undertake the inspection.
Site Master File/Quality Manual

Part of the reporting aspects of the inspection can be addressed by receiving information on
related company details, e.g. details of the company's facilities, personnel structure and
operating procedures including manufacturing activities, prior to inspection.
In the past, it was normal for the inspectors to spend some time, while on site, gathering this
information. To reduce inspection time, and obvious expense to the inspectee, it is expected
that this information should be prepared, in the form of a 'Site Master File' for a medical
product manufacturer, or a 'Quality Manual' for a medical device manufacturer, by the
inspectee for use by FDA GMP Inspectors.
It is requested that the Site Master File/ Quality Manual be enclosed, prepared and forward
these documents as soon as possible to the FDA Philippines.
For further information or queries regarding this application contact the following:
Food and Drug Administration Philippines

Civic Drive, Filinvest Corporate City,
Alabang, Muntinlupa City, Philippines 1781
Telephone No.: 857-1900

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ANNEX D

Application Form for

Postal: The Director General

TO BE COMPLETED BY THE PHILIPPINE DRUG IMPORTER

Manufacturing is defined as engaging in any operation involved in the production of drugs

MANUFACTURING SITE ADDRESS:

1.

2.

3.

4.

5.

6.

7.

8.

9.

*National Identification Number/Passport No.:

No. of years of relevant experience:

Contract manufacturer Contract Assembler

Official e-mail address:

Official e-mail address:

3. Scope of *Manufacturing / Assembling Activities (please specify):

1. Name of testing laboratory:

Official E-mail Address:

2. Types of analytical tests performed:

2.

3.

4.

5.

6.

7.

8.

9.

Approximate date when ready for inspection

Site Master File/Quality Manual

Food and Drug Administration Philippines

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