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QUESTIONNAIRE TO CARRY OUT THE REGISTRATION OF FACILITIES THE FDA (FOOD FACILITY REGISTRATION)
Below is a questionnaire with a series of questions to complete your installation registration with the FDA. Please fill it with the required information:
1 2 3 4 5 6 7 8 9 9a 9a2 9b 9b2 10
Section 1. Type of Registration

Where is the location of the Facility or factory? *

Are you a new owner of an already registered factory or facility? *

What is the title of the previous owner? *

What is the name of the previous owner? *

What is the previous owner's registration number? *

SECTION 2. NAME OF FACILITY/ ADDRESS

Name of the facility or factory *

Company suffix (Company, corporation, etc) *

Country *

Street name and number (1) *

Street name and number (2) *

Postal Code *

City *

State/Province/Territory *

Country phone code *

Telephone area code *

Facility phone number *

Extension (if applicable) *

Country fax code (optional) *

Telephone area code (optional) *

Facility fax number (optional) *

Facility Email *

Unique facility identifier or DUNS number * If you do not have a DUNS number, you can process it through the company by requesting the DUNS NUMBER REQUIREMENT format

SECTION 3. PREFERRED MAILING ADDRESS INFORMATION (OPTIONAL)
This section is OPTIONAL, but if your facility has a preferred mailing address, you can fill out this section

Facility or factory name *

Company suffix (Company, corporation, etc) *

Country *

Street name and number (1) *

Street name and number (2) *

Postal Code*

City *

State/Province/Territory *

Country phone code *

Telephone area code *

Facility phone number *

Extension (if applicable) *

Country fax code (optional) *

Telephone area code (optional) *

Facility fax number (optional) *

Facility Email *

SECTION 4. Parent company or corporate (OPTIONAL)
This section is OPTIONAL, if your company belongs to a corporation and the corporate data is different from the ones provided in section 2 or 3.

Name of the company *

Company suffix (Company, corporation, etc) *

Country *

Street name and number (1) *

Street name and number (2) *

Postal Code *

City *

State/Province/Territory *

Country phone code *

Telephone area code *

Facility phone number *

Extension (if applicable) *

Country fax code (optional) *

Telephone area code (optional) *

Facility fax number (optional) *

Facility Email *

SECTION 5. COMPANY EMERGENCY CONTACT

Title (Mr. Mrs, Miss) *

First name (Optional) *

Middle name (Optional) *

Last name (optional) *

Position (Director, Manager, Plant Manager, etc) (Optional) *

Country telephone code *

Code of the city of the emergency contact *

Emergency contact phone number *

Extension number (if applicable) *

Emergency contact email *

SECTION 6. TRADE NAMES
If your company uses an alternative business name to the name provided in section 2, you can indicate it here

Alternative business name *

SECTION 7. UNITED STATES AGENT (US Agent)
This section is required for successful registration of facilities outside of the United States. To be filled out by the US Agent

Is the agent an individual, corporate, company or association? *

Title (optional) *

Names *

Surnames *

Country/Area *

Street name and number (1) *

Street name and number (2) *

Postal Code *

City *

State/Province/Territory *

Telephone area code *

US Agent phone number *

Extension (if applicable) *

US Agent emergency phone number (this number must be available 24 hours a day, 365 days a year) *

US Agent Fax Number (Optional) *

US Agent Email *

SECTION 8. PERIODS OF OPERATION OF THE COMPANY
If your company operates seasonally, you have the option to indicate in which periods it operates (for example, 2 harvest periods, etc.).
Indicate the approximate months during which the facility or company works.

Operation periods for harvest 1 *

Operation periods for harvest 2 *

SECTION 9. COMPANY CATEGORY
Indicate the category of activities carried out by your company
SECTION 9a. CATEGORIES FOR COMPANIES THAT PROCESS FOOD FOR HUMAN CONSUMPTION
Select the category or categories of your company

If the food you make does not fall into any of the categories, you can describe it here: *

SECTION 9a. TYPE OF COMPANY ACTIVITIES (Food for human consumption)
According to the selected activities, select the type of activities performed by the company

Other activities: *

SECTION 9b. CATEGORIES FOR COMPANIES THAT PROCESS FEED FOR ANIMAL CONSUMPTION
Select the category or categories of your company

If the category of food you process is not listed, describe it: *

SECTION 9b. TYPE OF COMPANY ACTIVITIES (Food for animal consumption)
According to the selected activities, select the type of activities performed by the company

Other type of activity: *

SECTION 10. OWNER, OPERATOR OR AGENT IN CHARGE INFORMATION

Name of the entity or person that owns, operates or agents in charge of the company *

Country *

Street name and number (1) *

Street name and number (2) *

Postal Code *

City *

State/Province/Territory *

Country phone code *

Telephone area code *

Phone number *

Extension (if applicable) *

Country fax code (optional) *

Telephone area code (optional) *

Fax number (optional) *

Email address *

Your registration has been sent successfully.
You will receive an e-mail with the confirmation.

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