FDA REQUIREMENTS FOR CHANGE OF PHARMACIST/ADDITIONAL PHARMACIST:

1. Duly Accomplished INTEGRATED FORM/APPLICATION FORM with picture and signature of

OWNER & PHARMACIST. Kindly COMPLETE the details needed for the application form.
2. Photocopy Copy of CERTIFICATIONS or OFFICIAL RECEIPTS for any VARIATIONS (previous
Change of Pharmacist, Previous Change ownership, previous change location) – IF THERE’S
ANY AMMENDMENT
3. Pharmacist Documents
- PRC License – COLORED copy VALID PRC License front and back
- FDA seminar on A.O 34 (CERTIFICATE OR REPLIED EMAIL FROM FDA ACADEMY IF NOT
YET ATTENDED THE SEMINAR)
- For a.o 34 pls go to www.fda.gov.ph search academy and apply for the seminar.
We need the screenshot of replied email of the fda as a proof.
http://www.fda.gov.ph/industry-corner/downloadables/210-fda-academy-
forms/70026-fda-academy-e-nroll-e-course-registration
- Resignation letter of the RPH from previous employer with LTO number and
noted by or AFFIDAVIT of NO connection to other Drugstore

4. Commitment letter (Pharmacy Asst. NCIII Certification Training Course) SIGNED BY THE
OWNER
5. Risk Management Plan (Please see attached guidelines)

6. Location Plan [GPS Coordinates (GOOGLE MAP)] www.gps-coordinates.net

7. DTI – for single proprietor or SEC copy –for corporation
8. PAYMENT of Php 510
9. Photocopy of LTO and also a PHOTOCOPY of OFFICIAL RECEIPT of the LAST RENEWAL
PAYMENT if there’s any.

FOR SINGLE PROPRIETORSHIP:

- KINDLY SUBMIT POWER OF ATTORNEY WHEN THE AUTHORIZED REPRESENTATIVE IS NOT

THE OWNER OF THE ESTABLISHMENT
FOR CORPORATION:

- KINDLY SUBMIT A SECRETARY’S CERTIFICATE OR BOARD RESOLUTION AUTHORIZING THE

PERSON IN CHARGE IN BEHALF OF THE CORPORATION

***ALL DOCUMENTS in A-4 sized bondpaper.

**** We will only submit your application upon completion of the documents to avoid any
inconvenience upon submission.