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Department of Agriculture

BUREAU OF PLANT INDUSTRY


National Plant Quarantine Services Division
692 San Andres Street, Malate, Manila, Philippines
Email Address: npqsd.bpi@buplant.da.gov.ph
Tel. No.: (02) 8525-7909, (02) 8525-2987 ǀ Website: buplant.da.gov.ph

Application for Inspection and ______________________________


Phytosanitary Certification Date

The Director
Bureau of Plant Industry
Manila

Sir:

I/We _________________________________________________________________________________________
(Name, Address & Telephone No. of Exporter)
___________________________________________________ hereby request for inspection and certification of
the following plants/planting materials/plant products intended for export:

Common Name :
Scientific Name :
Quantity * :
Description and No. of Packages :
Source of Plants/Planting Materials/
Plant Products :
Name, Address of Consignee :

Date and Place of Inspection Desired :


Port of Entry :
Means of Conveyance :
Departure Date :
Import Permit No./Additional
Declaration/Treatment (if any) :

STAMP OF SERVICE
_______________________________________________________
Signature over Printed Name of Applicant/
Authorized Representative

*For Plants - No. of Pieces


*For Planting Materials - Weight in Kilos
and Plant Products

EFFECTIVITY DATE: February 24, 2023


FORM NO.: BPI “Q” Form No. 10
REVISION NO.: 0 Page 1 of 1

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