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Courseregistration Form

Abegail Baylosis applied to take the Unified Licensing Seminar course offered by the Philippines Food and Drug Administration Academy. She provided her personal details including name, address, contact information, date of birth, and gender. Her professional background includes working as a pharmacist for Generika Drugstore since October 2018. The terms and conditions of the course registration include a non-refundable fee, limited options for rescheduling or transferring registration, requirements for attendance and timely payment. FDA reserves the right to cancel or reschedule courses with short notice and move registrants to the next available course.

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Benjamin Dagmil Zamora III
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205 views1 page

Courseregistration Form

Abegail Baylosis applied to take the Unified Licensing Seminar course offered by the Philippines Food and Drug Administration Academy. She provided her personal details including name, address, contact information, date of birth, and gender. Her professional background includes working as a pharmacist for Generika Drugstore since October 2018. The terms and conditions of the course registration include a non-refundable fee, limited options for rescheduling or transferring registration, requirements for attendance and timely payment. FDA reserves the right to cancel or reschedule courses with short notice and move registrants to the next available course.

Uploaded by

Benjamin Dagmil Zamora III
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
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Republic of the Philippines

Department of Health
FOOD AND DRUG ADMINISTRATION

COURSE REGISTRATION FORM


Date Applied 30 August 2018
PERSONAL DATA
Name FIRSTE.NAME
Abegail Baylosis M.I. LAST NAME
Home Address Purok Libertad Barangay Poblacion, Sto. Nino, South Cotabato
Telephone No. Facsimile Email [email protected]
Birthdate January 18, 1997 Gender Female Cellphone No. 09090012160
PROFESSIONAL BACKGROUND
Company Name GENERIKA DRUGSTORE
Company Address Minas Bldg. JP Laurel St., Surallah South Cotabato
Department/Division Position PHARMACIST
Date of Employment 17 October 2018 Telephone No.
Industry Drug Facsimile

** For QPIRA Applicants Only


Length of Experience as company Regulatory Affairs Officer (Select One)
Company Name
Company Address
Name of Contact Person
Email Cellphone No.
Facsimile Telephone No.
For more than one company please include it in the body of the email following the above format
TYPE OF COURSE (please select a training course)
UNIFIED LICENSING SEMINAR CODE: ULS

TERMS AND CONDITIONS


1. Registration fee is non-refundable.
2. Changing of date is allowed once only for the same paid course. Notify and e-mail a formal letter of request addressed to the FDA Academy containing the following in
the SUBJECT field: RESCHED-Name of the registered participant/Date of confirmed schedule/Control Code (TR) at least seven (7) working days prior to the
commencement of the course. Our office will re-schedule contingent on the next available date.
3. Transferring or changing of participant is also allowed once only for the same paid course. Notify and e-mail a formal letter of request addressed to the FDA Academy
containing the following in the SUBJECT field: TRANSFER-Name of the registered participant/Date of confirmed schedule/Control Code (TR) and the Name of the
replacement and attached the requirements as per FDA Memorandum Circular 2013-016: GUIDELINES ON ELECTRONIC REGISTRATION FOR TRAINING AND
SEMINARS (E-COURSE REGISTRATION) at least seven (7) working days prior to the commencement of the course. Our office will process the request upon approval of
your application.
4. Always be present before 8:00 am for the registration. Course will start at exactly 8:15 am. Late comers will not be accepted and their registration fee will be
automatically forfeited.
5. Absence/Non-appearance during the confirmed training course automatically forfeits the registration fee.
6. ASSESSMENT FORM has a five (5) working-day validity once sent. Failure to pay within 5 working days will automatically cancel the application and a new
registration form must be submitted.
7. Completed training registration form shall be emailed to [email protected] or [email protected] following the prescribed format (see GUIDELINES ON
ELECTRONIC REGISTRATION FOR TRAINING AND SEMINARS)
8. FDA reserves the right to cancel or re-schedule courses within three (3) day-notice. In the event of cancellation, all pre-paid fees will automatically move towards the
next available course.
9. Bring a copy of the confirmation slip on the day(s) of the training course. A confirmation slip is required for attendance and release of certificates.
✔ I understand that by selecting this checkbox, I have read and accepted the terms and conditions stated on this form.

NOTE: All fields are mandatory. Do not leave any blank spaces put N/A if not applicable.
For any other concerns please do not hesitate to email [email protected] or call 877-0259.

FDAA-Form 2013-01/ Effectivity: 8 August 2018 Rev. 8 THIS FORM IS NOT FOR SALE
Civic Drive, Filinvest Corporate City, Alabang, City of Muntinlupa 1781 Philippines
Trunkline: 857-1900 or 165-332 Fax: 8070751 Email: [email protected]
www.fda.gov.ph

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