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NMIS affidavit of undertaking for product registration
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_________________________________ of legal age, ____________________________________
(name of applicant)
(position in the company)
and/or duly authorized representative of _____________________________________________
(name of company and address)
__________________________________________________________, after having been sworn
in accordance with law, hereby declare that:
1. the aforementioned company has imported from _________________________________
(country of origin)
the food products: see attached product list
2. the said importation is covered by the sales invoice no. _______________________ of the
______________________________, copy of which is cross-checked with the original and
(source/principal of the importer)
attached as Annex A;
3. the applicant company has a valid Accreditation as an importer, Accreditation No.
________ covering the said shipment.
4. the said products are not adulterated nor misbranded, and contain ingredients and
additives that are permitted for use in human food and in accordance with relevant
regulations issued by NMIS.
5. as duly authorized person of the _____________________________________________
He undertakes to be responsible and accountable for the quality, safety and truth in the
labeling declaration of the said food product.
6. He further undertakes to indicate his company name and address by stick-on labeling or
by other means of the labeling of the products in the market.
7. He furthermore understands and agrees that the products may be subjected to NMIS
laboratory examination at any time to verify the products safety, quality and conformity
with labeling claims and that the cost of laboratory examination shall be charged to them.
8. He executed this affidavit to confirm the truth of the foregoing.
_________________________ at ____________________________________________
(Place of execution)
Subscribed and sworn to before me this ______ day of __________ with Issued on __________ at