Application for Import Licence for Water or Milk

Section 143 Public Health Act , Regulation 4 Milk Regulations

PUBLIC HEALTH ACT, SECTION 143
MILK REGULATIONS 1988, REG.4

Name of Applicant: *

Address *

Billing Address *

Date submitting sample: *

Full name of product: *

Full description of sample according to label: *

Please proceed to analyse the abovementioned sample at my expense and invoice
me accordingly.

Name *

Capacity *

Date *

Email Address

End Section

Applicant will be required to sign application form prior to document being issued by the Agency.

I certify that the information contained in this Application is true to the best of my knowledge and belief. *

Yes

* obligatory fields

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