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					                                          Required Information for FDA Prior Notice Submission

                                          Prior Notice is required for all food and food products for human or
                                          animal consumption imported into the United States. This form
                                          must be completed in English.

DHL AWB No.                                                                     Date of shipment

Shipper Name                                                                    FDA Registration No.

Contact                                                                         Phone Number

Address




Consignee Name                                                                  FDA Registration No.

Contact                                                                         Phone Number

Address




Commodity shipped (Information for each article of food must be identified separately. This includes
changes in size or type of packaging or in how the food was prepared)
Description (common, usual, or market name)

Quantity (number of packages at the smallest unit)   Package size (include unit of measure)

HTS                                                  FDA Product Code

Country of Origin/Production

Name and Address of Manufacturer                     Manufacturer Registration No.




Description (common, usual, or market name)

Quantity (number of packages at the smallest unit)   Package size (include unit of measure)

HTS                                                  FDA Product Code

Country of Origin/Production

Name and Address of Manufacturer                     Manufacturer Registration No.
                                                                        FDA Prior Notice Submission - Page 2



Description (common, usual, or market name)

Quantity (number of packages at the smallest unit)   Package size (include unit of measure)

HTS                                                  FDA Product Code

Country of Origin/Production

Name and Address of Manufacturer                     Manufacturer Registration No.




Description (common, usual, or market name)

Quantity (number of packages at the smallest unit)   Package size (include unit of measure)

HTS                                                  FDA Product Code

Country of Origin/Production

Name and Address of Manufacturer                     Manufacturer Registration No.




Description (common, usual, or market name)

Quantity (number of packages at the smallest unit)   Package size (include unit of measure)

HTS                                                  FDA Product Code

Country of Origin/Production

Name and Address of Manufacturer                     Manufacturer Registration No.




Description (common, usual, or market name)

Quantity (number of packages at the smallest unit)   Package size (include unit of measure)

HTS                                                  FDA Product Code

Country of Origin/Production

Name and Address of Manufacturer                     Manufacturer Registration No.

				
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