Form 1

HALAL DEVELOPMENT INTITUTEOF THE PHILIPINES

Central Building, 3rd Flr. 37 P.A. Bernardo Cor. Malabito St. Cubao, Quezon City

I. NAME OF COMPANY: _______________________________________________

____________________________________________________________________
Address: _____________________________________________________________
_____________________________________________________________________
Telephone and e-mail:__________________________________________________
Permit License No. from DTI or SEC: _____________________________________
Date Issued: __________________________Valid until:
_______________________

II. ITEMS TO BE APPLIED:

(Specify the product whether Food or Non-Food)
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
5. _____________________________________________________________________
6. _____________________________________________________________________
(Attached separate Sheet if necessary)

III. IS THE PRODUCT LOCALLY MANUFACTURED? Yes________ No__________

If no, state country origin:

________________________________________________
_____________________________________________________________________

If yes, state how many plant(s) and addresses:

________________________________
_____________________________________________________________________

I hereby certify that the above answers are true and correct.

______________________________________
Signature over Printed Name
Position