1) Applicant's information (individual)

Title *

 Mr.   Mrs.   Ms.

Full Name *

I.D. number. *

Phone Number *

Current Address *

1) Information of the applicant (juristic person)

The name's a legal agent. *

Legal entity registration number *

Name of authorized person signing *

Location *

Phone Number *

Office address (juristic person) *

Request a certificate for *

 Places that sell food   Food storage premises

Establishment name/shop name *

Food type/business type *

Usable area (square meters) *

Business location *

Purpose of request *

-- Select --Assembling document submission/agencyUsed as evidence of legal notification.Other