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Joint Affidavit

This document is a Joint Affidavit by two individuals in the Philippines regarding an application for a PDEA License to handle dangerous drugs. It asserts that the drugs will be used solely for legitimate business purposes and outlines compliance with relevant laws. The affidavit is executed to attest to the truth of the statements made and for legal purposes.

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Issa Marie
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246 views1 page

Joint Affidavit

This document is a Joint Affidavit by two individuals in the Philippines regarding an application for a PDEA License to handle dangerous drugs. It asserts that the drugs will be used solely for legitimate business purposes and outlines compliance with relevant laws. The affidavit is executed to attest to the truth of the statements made and for legal purposes.

Uploaded by

Issa Marie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

REPUBLIC OF THE PHILIPPINES )

________________ ) S.S.

JOINT AFFIDAVIT

WE, _______________and _______________, both Filipinos of legal ages, single and married, respectively,
and with business address at Poblacion, Talibon, after having been duly sworn to in accordance with law hereby depose
and state that:

1. _____________ is a [ ] new
Applicant [ / ] for renewal [ ] for amendment of PDEA License to handle the following dangerous drugs, to wit:

Name of Dangerous Drug/s Purpose of Annual Projected Supplier/s


Handling Quantity

2. The above cited dangerous drug/s shall be used solely for the legitimate purpose governing the
nature of the applicant’s legitimate business and in no case will it be diverted for illegal purposes.

3. The PDEA License of N/A expired on N/A_ and


the latest Semi-Annual Report (SAR) for the period covering January to June _N/A / July to December N/A was submitted
belatedly before PDEA Compliance Service on ________due to _____________________.
NOTE: Paragraph 3 of this Affidavit shall sole applies only to Entity’s with late renewal of license and/or late
submission of SAR

4. From the foregoing, affiants hereby bind ourselves to comply with the pertinent provisions of R.A.
No. 9165 otherwise known as the “Comprehensive Dangerous Drugs Act of 2002” as well as the DDB Regulation No. 1
Series of 2014, and shall impose upon ourselves to conform therewith.

5. We are executing this Affidavit to attest the truth of the foregoing statement of facts and for whatever
legal intent and purpose that it may serve.

IN WITNESS HEREOF, we have hereunto set our hands this day of ,


20 at , Philippines.

(Pharma Group- Area Manager) (PDEA-Authorized Pharmacist/Authorized Signatory)


Affiant Affiant

SSUBSCRIBED AND SWORN to before me this day of______________________, 2024


____________, Philippines. Affiant personally exhibiting to me their and respectively issued by Processional Regulation
Commission, respectively, with expiry of the PRC on and, respectively.

Doc. No.
PageNo.
Book No.
Series of

NOTE: WHEN ACCOMPLISHING THIS AFFIDAVIT, PLEASE DELETE TEXTS IN RED FONT.
ACCOMPLISH PARAGRAPH 3 ONLY WHEN APPLICABLE
FM-CSVlrd-06_Rev_2_January 03, 2022

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